Healthcare Provider Details

I. General information

NPI: 1043239775
Provider Name (Legal Business Name): MICHAEL ARLIN LONG P.A.-C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 4TH ST.
DASSEL MN
55325
US

IV. Provider business mailing address

450 4TH ST. PO BOX 367
DASSEL MN
55325
US

V. Phone/Fax

Practice location:
  • Phone: 320-275-3358
  • Fax:
Mailing address:
  • Phone: 320-275-3358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9836
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: