Provider Demographics
NPI:1548217458
Name:LE, LONG (DPM)
Entity Type:Individual
Prefix:
First Name:LONG
Middle Name:
Last Name:LE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:7600 FRANCE AVE S STE 1100
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5924
Mailing Address - Country:US
Mailing Address - Phone:763-545-7545
Mailing Address - Fax:952-929-2067
Practice Address - Street 1:7600 FRANCE AVE S STE 1100
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5924
Practice Address - Country:US
Practice Address - Phone:952-929-3566
Practice Address - Fax:952-929-3358
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN759213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN273029400Medicaid
MNV07140Medicare UPIN
MN480000570Medicare ID - Type Unspecified