Individual
CHRISTOPHER M LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9200 W WISCONSIN AVE, OTOLARYNGOLOGY, MILWAUKEE, WI 53226-3522
(414) 805-5580
(414) 805-8324
Mailing address
9200 W WISCONSIN AVE, OTOLARYNGOLOGY, MILWAUKEE, WI 53226-3522
(414) 805-5580
(414) 805-8324
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
39103
WI
207YP0228X
Pediatric Otolaryngology Physician
39103
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659382117
—
WI
05
—
34075100
—
WI
Enumeration date
08/10/2006
Last updated
04/09/2015
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