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General NPI Number Information
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NPI Number | 1962526624
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Entity Type | Organization
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Legal Business Name | LONG LAKE PODIATRY PC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 2914 E LONG LAKE RD
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City | TROY
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State | MI
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Zip | 48085-3780
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Country | US
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Telephone | 248-528-0709
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Fax | 248-528-1807
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Provider Business Mailing Address
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Address Line | 2914 E LONG LAKE RD
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City | TROY
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State | MI
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Zip | 48085-3780
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Country | US
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Telephone | 248-528-0709
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Fax | 248-528-1807
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | AMY DOOLEY
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Credential |
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Telephone | 248-528-0709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 5901001005
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License Number State | MI
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