Provider Demographics
NPI:1770586182
Name:LONGLEY, MICHAEL CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHARLES
Last Name:LONGLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:13616 CALIFORNIA ST
Mailing Address - Street 2:STE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-5335
Mailing Address - Country:US
Mailing Address - Phone:402-496-0404
Mailing Address - Fax:402-496-0517
Practice Address - Street 1:13616 CALIFORNIA ST
Practice Address - Street 2:STE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-5335
Practice Address - Country:US
Practice Address - Phone:402-496-0404
Practice Address - Fax:402-496-0517
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE18765207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE03070OtherBCBS
NE200031845OtherRAILROAD MEDICARE
NE47081304012Medicaid
IA3989848Medicaid
NE270594Medicare PIN
NEF21278Medicare UPIN