Individual
DR. LANCE P LONGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1220 DEWEY AVE, WAUWATOSA, WI 53213-2598
(414) 773-4311
(414) 454-6747
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
(414) 671-8860
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
37822
WI
2084P0802X
Addiction Psychiatry Physician
74570
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32273000
—
WI
Enumeration date
08/23/2006
Last updated
09/18/2024
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