MEDICARE: DR. JACK WILEY DELONG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	4301029955	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	P52387	OTHER	MI	BCN MICHIGAN

General Provider Information

NPI Number	:	1356349039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK WILEY DELONG M.D.

Provider Business Mailing Address
First Line	:	111 W 24TH ST
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49423-4791
Country	:	US
Telephone Number	:	616-396-2325
Fax Number	:	616-396-0317

Provider Business Practice Location Address
First Line	:	1900 BROTHER GEENEN WAY
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34236-7102
Country	:	US
Telephone Number	:	941-556-3220
Fax Number	:	941-955-8214

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/14/2019

Similar Medicare Providers

1255085452 — REGINA DOLORES PERRY APRN
Practice Location Address:

1900 BROTHER GEENEN WAY
SARASOTA, FL
34236-7102

Practice Phone: 941-529-0200
Practice Fax: 833-606-0218

1306849211 — DR. HOWARD HARVEY TESSLER M.D.
Practice Location Address:

1900 BROTHER GEENEN WAY
SARASOTA, FL
34236-7102

Practice Phone: 941-556-3220
Practice Fax: 941-955-8214

1689679367 — DR. ROBERT JOSEPH GIALANELLA MD
Practice Location Address:

1900 BROTHER GEENEN WAY
SARASOTA, FL
34236-7102

Practice Phone: 941-556-3220
Practice Fax: 941-955-8214

1225035918 — DR. DONALD M SNYDER MD
Practice Location Address:

SENIOR FRIENDSHIP CENTERS, INC. , 1900 BROTHER GEENEN WAY
SARASOTA, FL
34236-7102

Practice Phone: 941-556-3215
Practice Fax: 941-955-8214

1528067386 — SAMI F MUHTADIE MD
Practice Location Address:

1900 BROTHER GEENEN WAY
SARASOTA, FL
34236-7102

Practice Phone: 941-556-3233
Practice Fax: 941-955-8214

1649279878 — DR. MARIA TOTH GEORGIEV M.D.
Practice Location Address:

1900 BROTHER GEENEN WAY , SENIOR FRIENDSHIP CENTERS, INC.
SARASOTA, FL
34236-7102

Practice Phone: 941-556-3215
Practice Fax: 941-955-8214

Directions to “ DR. JACK WILEY DELONG M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.