Individual
MICHAEL LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
7150 CLEARVISTA DR, INDIANAPOLIS, IN 46256-1695
(317) 621-5890
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28238168A
IN
367500000X
Certified Registered Nurse Anesthetist
523585
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300008953
—
IN
Enumeration date
02/28/2006
Last updated
11/27/2023
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