Provider Demographics
NPI:1619028271
Name:LONG, ELIZABETH K (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:LONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:K
Other - Last Name:PAULSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:20375 W 151ST ST
Mailing Address - Street 2:SUITE 463
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7218
Mailing Address - Country:US
Mailing Address - Phone:913-782-8577
Mailing Address - Fax:913-782-2616
Practice Address - Street 1:20375 W 151ST ST
Practice Address - Street 2:SUITE 463
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7218
Practice Address - Country:US
Practice Address - Phone:913-782-8577
Practice Address - Fax:913-782-2616
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0427739208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
31382033OtherBCBS OF KANSAS CITY
7605358OtherAETNA
KS100416840CMedicaid
P00297952OtherRAILROAD MEDICARE
31382033OtherBCBS OF KANSAS CITY
H59145Medicare UPIN