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NPI Code Detail

MEDICARE: DR. TIMOTHY J LONG MD

MEDICARE: DR. TIMOTHY J LONG MD
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 Physician036094444IL

General Provider Information

NPI Number : 1528081239
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIMOTHY J LONG MD
Provider Business Mailing Address
First Line : 1276 N CLYBOURN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60610-2089
Country : US
Telephone Number : 312-337-1073
Fax Number : 312-337-7616
Provider Business Practice Location Address
First Line : 1276 N CLYBOURN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60610-2089
Country : US
Telephone Number : 312-337-1073
Fax Number : 312-337-7616
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2006
Last Update Date : 10/29/2020

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