Michael E Longevin MDSC

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

036-072215 Issued in IL

Legal business name

MICHAEL E LONGEVIN MDSC

Practice address

5401 N Knoxville Ave
Suite 112
Peoria, IL 61614-5098

Phone

(309) 692-5828

Fax

(309) 692-5904

NPI assigned

Sep 11, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michael E Longevin, MD

Title

President

Phone

(309) 692-5828

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1284163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285200000000",
    "number": "1578870556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5401 N KNOXVILLE AVE",
            "address_2": "SUITE 112",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145098",
            "telephone_number": "309-692-5828",
            "fax_number": "309-692-5904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5401 N KNOXVILLE AVE",
            "address_2": "SUITE 112",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145098",
            "telephone_number": "309-692-5828",
            "fax_number": "309-692-5904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL E LONGEVIN MDSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-11",
        "last_updated": "2010-09-23",
        "status": "A",
        "authorized_official_last_name": "LONGEVIN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-692-5828",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "IL",
            "license": "036-072215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Urology Physician in Peoria, IL
• Providers in Peoria, IL by specialty
• Urology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.