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NPI Code Detail

MEDICARE: NICOLE KATHRYN LONG MD

MEDICARE: NICOLE KATHRYN LONG MD
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
1208600000XSurgery Physician036178851IL

General Provider Information

NPI Number : 1518531946
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE KATHRYN LONG MD
Provider Business Mailing Address
First Line : 1500 S FAIRFIELD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60608-1782
Country : US
Telephone Number : 321-352-0994
Fax Number :
Provider Business Practice Location Address
First Line : 1500 S FAIRFIELD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60608-1782
Country : US
Telephone Number : 321-352-0994
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2021
Last Update Date : 06/04/2026

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Directions to “ NICOLE KATHRYN LONG MD” Practice Location

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