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General NPI Number Information
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NPI Number | 1770512170
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Entity Type | Individual
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Provider Name | CHARLES A LONGDON D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 10400 HALIGUS RD
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City | HUNTLEY
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State | IL
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Zip | 60142-9553
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Country | US
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Telephone | 224-654-0100
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Fax | 224-654-0105
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Provider Business Mailing Address
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Address Line | 10400 HALIGUS RD
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City | HUNTLEY
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State | IL
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Zip | 60142-9553
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Country | US
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Telephone | 224-654-0100
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Fax | 224-654-0105
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 44365-021
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036109417
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License Number State | IL
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