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NPI Code Detail

MEDICARE: GINGER LONG

MEDICARE: GINGER LONG
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
1171M00000XCase Manager/Care Coordinator6801069792MI

General Provider Information

NPI Number : 1346782836
Entity Type Code : Individual
Provider Name (Legal Business Name) : GINGER LONG
Provider Business Mailing Address
First Line : 38271 MOUND RD
Second Line : BLDG B SUITE 300
City : STERLING HEIGHTS
State : MI
Zip : 48310-3401
Country : US
Telephone Number : 586-477-2054
Fax Number : 517-676-5460
Provider Business Practice Location Address
First Line : 38271 MOUND RD
Second Line : BLDG B SUITE 300
City : STERLING HEIGHTS
State : MI
Zip : 48310-3401
Country : US
Telephone Number : 586-477-2054
Fax Number : 517-676-5460
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2016
Last Update Date : 11/15/2016

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