Provider Demographics
NPI:1801833272
Name:LONGI, MUHAMMED (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMED
Middle Name:
Last Name:LONGI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N READ ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441
Mailing Address - Country:US
Mailing Address - Phone:815-838-7337
Mailing Address - Fax:815-838-5007
Practice Address - Street 1:300 READ ST
Practice Address - Street 2:SUITE D
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-3265
Practice Address - Country:US
Practice Address - Phone:815-838-7337
Practice Address - Fax:815-838-5007
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-089100207RA0000X
IL0360891002080A0000X
IL03689100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-089100Medicaid
ILL84709Medicare PIN
IL036-089100Medicaid