Individual
ANITA L ONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2929 S ELLIS AVENUE, 1 KP, CHICAGO, IL 60616-3302
(312) 791-5344
(312) 791-2434
Mailing address
PO BOX 88487, CHICAGO, IL 60680-1487
(312) 791-2000
(312) 791-2076
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
01053424A
IN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
03093236
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360932362
—
IL
05
—
0360932362
—
IN
Enumeration date
08/31/2006
Last updated
07/08/2007
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