10D0896969 CLIA NUMBER - MILLENNIUM PHYSICIAN GROUP LLC

Laboratory Demographics

  • CLIA Code: 10D0896969
  • Facility Name: MILLENNIUM PHYSICIAN GROUP LLC
  • Facility Address: 4881 PALM BEACH BLVD STE 100
    FORT MYERS, FL
    ZIP 33905
  • Facility Phone: 239 693-9191
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JULIO L. RODRIGUEZ
  • NPI Number: 1316619182
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D0896969
LAB Type Physician Office
Facility Name MILLENNIUM PHYSICIAN GROUP LLC
Street 4881 PALM BEACH BLVD STE 100
City FORT MYERS
State FL
ZIP 33905
Phone 239 693-9191
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/23/2025
Certificate Expiration Date 10/22/2027
Facility Type Physician Office
Lab Director JULIO L. RODRIGUEZ

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This page was last updated on: 9/29/2025