10D0952479 CLIA NUMBER - MILLENNIUM PHYSICIAN GROUP

Laboratory Demographics

  • CLIA Code: 10D0952479
  • Facility Name: MILLENNIUM PHYSICIAN GROUP
  • Facility Address: 24600 TAMIAMI TRAIL S STE 500
    BONITA SPRINGS, FL
    ZIP 34134
  • Facility Phone: 941 764-1880
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GEORGE MESTAS
  • NPI Number: 1992477780
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D0952479
LAB Type Physician Office
Facility Name MILLENNIUM PHYSICIAN GROUP
Street 24600 TAMIAMI TRAIL S STE 500
City BONITA SPRINGS
State FL
ZIP 34134
Phone 941 764-1880
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/14/2024
Certificate Expiration Date 10/13/2026
Facility Type Physician Office
Lab Director GEORGE MESTAS

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