Individual
DR. AMANDA LEIGH LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
02004620A
IN
207R00000X
Internal Medicine Physician
Primary
5101024409
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/15/2013
Last updated
09/11/2023
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