Healthcare Provider Details

I. General information

NPI: 1891607982
Provider Name (Legal Business Name): LIVWELL LONGEVITY INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22260 GARRISON ST STE A
DEARBORN MI
48124-2208
US

IV. Provider business mailing address

22260 GARRISON ST STE A
DEARBORN MI
48124-2208
US

V. Phone/Fax

Practice location:
  • Phone: 133-696-0600
  • Fax: 313-696-0061
Mailing address:
  • Phone: 133-696-0600
  • Fax: 313-696-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICAH ANDREW CRAIG
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 313-696-0600