Provider Demographics
NPI:1356631139
Name:LONGO, JOHN MACLOU (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MACLOU
Last Name:LONGO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:RADIATION ONCOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-4400
Mailing Address - Fax:414-805-4369
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:RADIATION ONCOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-4400
Practice Address - Fax:414-805-4369
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2023-04-07
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Provider Licenses
StateLicense IDTaxonomies
WI575272085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1356631139Medicaid