Organization
MICHAEL E LONGEVIN MDSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL E LONGEVIN MD (PRESIDENT)
(309) 692-5828
Entity
Organization
Contact information
Practice address
5401 N KNOXVILLE AVE, SUITE 112, PEORIA, IL 61614-5098
(309) 692-5828
(309) 692-5904
Mailing address
5401 N KNOXVILLE AVE, SUITE 112, PEORIA, IL 61614-5098
(309) 692-5828
(309) 692-5904
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
036-072215
IL
Other
Enumeration date
09/11/2010
Last updated
09/23/2010
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