Provider Demographics
NPI:1932730256
Name:CEREESA E. LONGEST MD SC
Entity Type:Organization
Organization Name:CEREESA E. LONGEST MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CEREESA
Authorized Official - Middle Name:E
Authorized Official - Last Name:LONGEST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-253-4040
Mailing Address - Street 1:P.O. BOX 135
Mailing Address - Street 2:117 S COOK STREET
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-4311
Mailing Address - Country:US
Mailing Address - Phone:847-253-4040
Mailing Address - Fax:847-787-1489
Practice Address - Street 1:1100 WEST CENTRAL ROAD
Practice Address - Street 2:SUITE 205
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2465
Practice Address - Country:US
Practice Address - Phone:847-253-4040
Practice Address - Fax:847-253-3028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-27
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-090336OtherSTATE LICENSE NUMBER
1467438341OtherTYPE 1 NPI