Individual
HOLLY LONGSTREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1354 S LAKE PARK AVE STE B, HOBART, IN 46342-5964
(219) 945-4495
(219) 703-6701
Mailing address
8558 BROADWAY, MERRILLVILLE, IN 46410-7032
(219) 392-7084
(219) 703-6854
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02004654A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201299700
—
IN
Enumeration date
06/05/2012
Last updated
01/10/2024
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