Provider Demographics
NPI:1528012820
Name:LONG, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11219 FINANCIAL CENTRE PKWY
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3800
Mailing Address - Country:US
Mailing Address - Phone:501-225-8346
Mailing Address - Fax:501-217-9819
Practice Address - Street 1:11219 FINANCIAL CENTRE PKWY
Practice Address - Street 2:SUITE 215
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3800
Practice Address - Country:US
Practice Address - Phone:501-225-8346
Practice Address - Fax:501-217-9819
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2008-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARE-25762085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149923001Medicaid
AR1104084599OtherTHE VEIN CENTER, PLLC
AR5M584G038Medicare PIN
AR1104084599OtherTHE VEIN CENTER, PLLC