Long, Kenneth Michael
Long, Kenneth Michael is an individual health care provider with primary practice located at 5907 Highway 90 , Moss Point MS 39563-6536. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Long, Kenneth Michael can be contacted via phone (228) 769-2611.Contact Information
Primary practice address
5907 Highway 90
Moss Point MS 39563-6536
Phone: (228) 769-2611
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 311654 | Louisiana |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 22826 | Mississippi |
Profile Details
| NPI number | 1346535390 |
|---|---|
| LBN Legal business name | Long, Kenneth Michael |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 17th, 2011 |
| Last updated | Jan 26th, 2021 - about 3 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1346535390 | NPPES |
| Mississippi | Other | P01332510 | RAILROAD MEDICARE |
| Mississippi | MEDICAID | 08224277 | RAILROAD MEDICARE |
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