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NPI Code Detail

MEDICARE: DR. STEVEN CHARLES LONG M.D.

MEDICARE: DR. STEVEN CHARLES LONG 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
1207R00000XInternal Medicine Physician21702MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1107307OTHERMNUCARE MN #
24044526OTHERMNAETNA INS
30408794OTHERMNMEDICA #
41000842OTHERMNPREFERRED ONE
508F70LOOTHERMNBCBS OF MN
621984OTHERMNAMERICA'S PPO
7HP19902OTHERMNHEALTHPARTNERS

General Provider Information

NPI Number : 1053343970
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEVEN CHARLES LONG M.D.
Provider Business Mailing Address
First Line : 6401 UNIVERSITY AVE NE
Second Line :
City : FRIDLEY
State : MN
Zip : 55432-4341
Country : US
Telephone Number : 763-572-5710
Fax Number : 763-571-3008
Provider Business Practice Location Address
First Line : 4000 CENTRAL AVE NE
Second Line :
City : COLUMBIA HEIGHTS
State : MN
Zip : 55421-2968
Country : US
Telephone Number : 763-572-5710
Fax Number : 763-782-8100
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2006
Last Update Date : 07/09/2007

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Directions to “ DR. STEVEN CHARLES LONG M.D.” Practice Location

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