Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ageless Living Institute LLC

Organization Internal Medicine Physician · NPI 1770160269

Ageless Living Institute LLC is an Internal Medicine Physician in Prescott, Arizona. Registered with an NPI since 2021.

In the registry since
2021
Specialties on file
7
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1670 Willow Creek Rd Ste A
Prescott, AZ 86301-1112
Phone: (928) 255-5191
Fax: (928) 316-9703
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X
Internal Medicine Physician Taxonomy 207R00000X
Neurological Surgery Physician Taxonomy 207T00000X
Physical Medicine & Rehabilitation Physician Taxonomy 208100000X
Pain Medicine (Physical Medicine & Rehabilitation) Physician Taxonomy 2081P2900X
Physician Assistant Taxonomy 363A00000X
Surgical Physician Assistant Taxonomy 363AS0400X

Record details

NPI number1770160269
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Mark Kledzik — Member · (928) 255-5191
NPI enumeratedMarch 29, 2021
Last updated in NPPESFebruary 2, 2023
Certification dateFebruary 2, 2023
Mailing address1670 Willow Creek Rd Ste A, Prescott, AZ 86301-1112

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