MEDICARE: DR. GRAHAM W 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
1	2086S0129X	Vascular Surgery Physician	4301051392	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932179132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRAHAM W LONG MD

Provider Business Mailing Address
First Line	:	525 E BIG BEAVER RD
Second Line	:	SUITE 125
City	:	TROY
State	:	MI
Zip	:	48083-1364
Country	:	US
Telephone Number	:	248-688-9860
Fax Number	:	248-688-9861

Provider Business Practice Location Address
First Line	:	525 E BIG BEAVER RD
Second Line	:	SUITE 125
City	:	TROY
State	:	MI
Zip	:	48083-1364
Country	:	US
Telephone Number	:	248-688-9860
Fax Number	:	248-688-9861

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	04/02/2021

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