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NPI Code Detail

MEDICARE: LONGEVITY CLINICAL LTC ASSOCIATES OF MICHIGAN PLLC

MEDICARE: LONGEVITY CLINICAL LTC ASSOCIATES OF MICHIGAN PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP2300XPrimary Care Nurse Practitioner
2207Q00000XFamily Medicine Physician
3363LG0600XGerontology Nurse Practitioner
4207QG0300XGeriatric Medicine (Family Medicine) Physician

General Provider Information

NPI Number : 1154992196
Entity Type Code : Organization
Provider Name (Legal Business Name) : LONGEVITY CLINICAL LTC ASSOCIATES OF MICHIGAN PLLC
Provider Business Mailing Address
First Line : 11770 US HIGHWAY 1 STE 102E
Second Line :
City : PALM BEACH GARDENS
State : FL
Zip : 33408-3052
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 26505 POWERS AVE
Second Line :
City : DEARBORN HEIGHTS
State : MI
Zip : 48125-1327
Country : US
Telephone Number : 313-291-6200
Fax Number :
Authorized Official
Title or Position : PROVIDER RELATIONS REPRESENTATIVE
Name : MICHELLE BYOWITZ
Credential :
Telephone Number : 561-850-4129
Provider Enumeration Date : 07/09/2021
Last Update Date : 03/03/2026

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