10D0965868 CLIA NUMBER - MILLENNIUM PHYSICIAN GROUP

Laboratory Demographics

  • CLIA Code: 10D0965868
  • Facility Name: MILLENNIUM PHYSICIAN GROUP
  • Facility Address: 13440 PARKER COMMONS BLVD STE 101
    FORT MYERS, FL
    ZIP 33912
  • Facility Phone: 239 432-9383
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DEBRA T. BLACK
  • NPI Number: 1760145742
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D0965868
LAB Type Physician Office
Facility Name MILLENNIUM PHYSICIAN GROUP
Street 13440 PARKER COMMONS BLVD STE 101
City FORT MYERS
State FL
ZIP 33912
Phone 239 432-9383
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/30/2025
Certificate Expiration Date 9/29/2027
Facility Type Physician Office
Lab Director DEBRA T. BLACK

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