Individual
LISA M LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1414 W FAIR AVE, STE 36, MARQUETTE, MI 49855-2675
(906) 225-3864
(906) 225-3851
Mailing address
4602 DEPT, CAROL STREAM, IL 60122-0021
(906) 225-3864
(906) 225-3851
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301074655
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080187364
RAILROAD MEDICARE
MI
05
—
4416083
—
MI
Enumeration date
10/28/2005
Last updated
04/21/2009
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