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

Longevity Vein Clinic LLC

Organization Internal Medicine Physician · NPI 1033902994

Longevity Vein Clinic LLC is an Internal Medicine Physician in Ballwin, Missouri. Registered with an NPI since 2025.

In the registry since
2025
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

15421 Clayton Rd Ste G1
Ballwin, MO 63011-3161
Phone: (314) 639-9475
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X

Record details

NPI number1033902994
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Ameen Bajwa — Cfo · (314) 954-4005
NPI enumeratedMay 23, 2025
Last updated in NPPESMay 23, 2025
Certification dateMay 23, 2025
Mailing address15421 Clayton Rd Ste G1, Ballwin, MO 63011-3161

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