10D0965335 CLIA NUMBER - MILLENNIUM PHYSICIAN GROUP LLC

Laboratory Demographics

  • CLIA Code: 10D0965335
  • Facility Name: MILLENNIUM PHYSICIAN GROUP LLC
  • Facility Address: 3611 TAMIAMI TRL STE B
    PORT CHARLOTTE, FL
    ZIP 33952
  • Facility Phone: 941 235-0542
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ARELIS M. MADERA
  • NPI Number: 1831852722
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D0965335
LAB Type Physician Office
Facility Name MILLENNIUM PHYSICIAN GROUP LLC
Street 3611 TAMIAMI TRL STE B
City PORT CHARLOTTE
State FL
ZIP 33952
Phone 941 235-0542
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/20/2025
Certificate Expiration Date 9/19/2027
Facility Type Physician Office
Lab Director ARELIS M. MADERA

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