10D0992651 CLIA NUMBER - MILLENNIUM PHYSICIAN GROUP, LLC

Laboratory Demographics

CLIA Number: 10D0992651

Facility Name: MILLENNIUM PHYSICIAN GROUP, LLC

Facility Address:
406 N INDIANA AVE - STE 4
ENGLEWOOD, FL
ZIP 34223
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Facility Phone Number: 941 787-7665

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1467540559

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	10D0992651
LAB Type	Physician Office
Facility Name	MILLENNIUM PHYSICIAN GROUP, LLC
Street	406 N INDIANA AVE - STE 4
City	ENGLEWOOD
State	FL
ZIP	34223
Phone	941 787-7665
CertificateType	4
CertificateEffectiveDate	10/23/2023
CertificateExpirationDate	10/22/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024