10D0979077 CLIA NUMBER - MILLENNIUM PHYSICIAN GROUP, LLC

Laboratory Demographics

  • CLIA Code: 10D0979077
  • Facility Name: MILLENNIUM PHYSICIAN GROUP, LLC
  • Facility Address: 14350 METROPOLIS AVE STE 1
    FORT MYERS, FL
    ZIP 33912
  • Facility Phone: 239 275-3036
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GLENN A. TOVAR DIAS
  • NPI Number: 1629731609
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D0979077
LAB Type Physician Office
Facility Name MILLENNIUM PHYSICIAN GROUP, LLC
Street 14350 METROPOLIS AVE STE 1
City FORT MYERS
State FL
ZIP 33912
Phone 239 275-3036
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/12/2024
Certificate Expiration Date 10/11/2026
Facility Type Physician Office
Lab Director GLENN A. TOVAR DIAS

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