Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 39103 | WI |
N | 207YP0228X | Pediatric Otolaryngology | 39103 | WI |
NPI | 1659382117 |
---|---|
Provider Name | Christopher M Long |
First Address | Milwaukee, WI 53226-3522 |
Second Address | Milwaukee, WI 53226-3522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 09/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1659382117 | (05) | WI |
34075100 | (05) | WI |
H34097 | (02) |