Provider Demographics
NPI:1144336223
Name:LONG, WILLIAM E (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:E
Last Name:LONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11 SALT CREEK LN STE 125
Mailing Address - Street 2:STE 125
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2902
Mailing Address - Country:US
Mailing Address - Phone:630-655-1177
Mailing Address - Fax:630-655-1192
Practice Address - Street 1:11 SALT CREEK LN STE 125
Practice Address - Street 2:STE 125
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2902
Practice Address - Country:US
Practice Address - Phone:630-655-1177
Practice Address - Fax:630-655-1192
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-090299207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
400280OtherMEDICARE GROUP PTAN
CN4921OtherRRMC
IL080193902Medicare ID - Type UnspecifiedRR MEDICARE #
400280OtherMEDICARE GROUP PTAN
ILE62348Medicare UPIN
ILL95208Medicare PIN