Provider Demographics
NPI:1053343970
Name:LONG, STEVEN CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:CHARLES
Last Name:LONG
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Gender:M
Credentials:MD
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Mailing Address - Street 1:6401 UNIVERSITY AVE NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4341
Mailing Address - Country:US
Mailing Address - Phone:763-572-5710
Mailing Address - Fax:763-571-3008
Practice Address - Street 1:4000 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-2968
Practice Address - Country:US
Practice Address - Phone:763-572-5710
Practice Address - Fax:763-782-8100
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
MN21702207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN107307OtherUCARE MN #
MN4044526OtherAETNA INS
MN0408794OtherMEDICA #
MN1000842OtherPREFERRED ONE
MN08F70LOOtherBCBS OF MN
MN21984OtherAMERICA'S PPO
MNHP19902OtherHEALTHPARTNERS
MN21984OtherAMERICA'S PPO