Long, Kathleen

Long, Kathleen is an individual health care provider with primary practice located at 5215 Holy Cross Pkwy Emergency Department, Mishawaka IN 46545-1469. She recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as her primary health care specialty. Long, Kathleen can be contacted via phone (574) 335-5000.

Contact Information

Primary practice address
5215 Holy Cross Pkwy Emergency Department Mishawaka IN 46545-1469
Phone: (574) 335-5000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 01028072A Indiana

Profile Details

NPI number 1154387132
LBN Legal business name Long, Kathleen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 26th, 2006
Last updated Dec 16th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154387132 NPPES
Indiana MEDICAID 100318630
Indiana Other 930101013
Indiana Other 000000181684
Indiana MEDICAID 104340083

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