Healthcare Provider Details

I. General information

NPI: 1639085384
Provider Name (Legal Business Name): LONGEVITY ORTHOPEDICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 S ROCHESTER RD
ROCHESTER HILLS MI
48307-4577
US

IV. Provider business mailing address

2708 S ROCHESTER RD
ROCHESTER HILLS MI
48307-4577
US

V. Phone/Fax

Practice location:
  • Phone: 586-214-7867
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK RYAN
Title or Position: OWNER
Credential: DO
Phone: 586-214-7867