| Longevity Vein Clinic LLC | |
|
15421 Clayton Rd Ste G1 Ballwin MO 63011-3161 | |
| (314) 639-9475 | |
| Not Available |
| Full Name | Longevity Vein Clinic LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 15421 Clayton Rd Ste G1, Ballwin, Missouri |
| Authorized Official Name and Position | Ameen M Bajwa (CFO) |
| Authorized Official Contact | 3149544005 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Longevity Vein Clinic LLC 15421 Clayton Rd Ste G1 Ballwin MO 63011-3161 Ph: (314) 639-9475 | Longevity Vein Clinic LLC 15421 Clayton Rd Ste G1 Ballwin MO 63011-3161 Ph: (314) 639-9475 |
| NPI Number | 1033902994 |
|---|---|
| Provider Enumeration Date | 05/23/2025 |
| Last Update Date | 05/23/2025 |
| Certification Date | 05/23/2025 |
| Medicare PECOS PAC ID | 7214413699 |
|---|---|
| Medicare Enrollment ID | O20260115002576 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033902994 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Mohammed Z Siddiqui |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730115973 PECOS PAC ID: 9537066998 Enrollment ID: I20040423001244 |
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