Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 4301056088 | MI |
NPI | 1003973272 |
---|---|
Provider Name | Randi J. Long |
First Address | Birmingham, MI 48009-0913 |
Second Address | Royal Oak, MI 48073 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 22/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3480240 | (05) | MI |
G76713 | (02) | MI |