Individual
KELLY BRENT LONGIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
727 KIRKWOOD MALL, BISMARCK, ND 58504-5753
(701) 712-4500
Mailing address
727 KIRKWOOD MALL, BISMARCK, ND 58504-5753
(701) 712-4500
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
PT 10482
ND
Other
Enumeration date
03/15/2007
Last updated
06/15/2023
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