Basic Information
| Provider Information | |||||||||
| NPI: | 1194739623 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LONG | ||||||||
| FirstName: | ALYS | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 E MICHIGAN AVE STE 370 | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489121897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5174844451 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 E MICHIGAN AVE STE 370 | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489121897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5174844451 | ||||||||
| FaxNumber: | 5174840291 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 05/12/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 5101017171 | MI | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 363A00000X | 5601003222 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.