Provider Demographics
NPI:1962817700
Name:NGUYEN, LONG (DO)
Entity Type:Individual
Prefix:
First Name:LONG
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3 NEENAH CTR FL 5
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3070
Mailing Address - Country:US
Mailing Address - Phone:920-787-4613
Mailing Address - Fax:920-787-5433
Practice Address - Street 1:N2934 STATE ROAD 22
Practice Address - Street 2:
Practice Address - City:WAUTOMA
Practice Address - State:WI
Practice Address - Zip Code:54982-5267
Practice Address - Country:US
Practice Address - Phone:920-787-4613
Practice Address - Fax:920-787-5433
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2023-12-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI72993207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100101735Medicaid