Basic Information
| Provider Information | |||||||||
| NPI: | 1053343970 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LONG | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | CHARLES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6401 UNIVERSITY AVE NE | ||||||||
| Address2: | |||||||||
| City: | FRIDLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554324341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635725710 | ||||||||
| FaxNumber: | 7635713008 | ||||||||
| Practice Location | |||||||||
| Address1: | 4000 CENTRAL AVE NE | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA HEIGHTS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554212968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635725710 | ||||||||
| FaxNumber: | 7637828100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 21702 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 107307 | 01 | MN | UCARE MN # | OTHER | 4044526 | 01 | MN | AETNA INS | OTHER | 0408794 | 01 | MN | MEDICA # | OTHER | 1000842 | 01 | MN | PREFERRED ONE | OTHER | 08F70LO | 01 | MN | BCBS OF MN | OTHER | 21984 | 01 | MN | AMERICA'S PPO | OTHER | HP19902 | 01 | MN | HEALTHPARTNERS | OTHER |