10D1013625 CLIA NUMBER - MILLENNIUM PHYSICIAN GROUP, LLC

Laboratory Demographics

  • CLIA Code: 10D1013625
  • Facility Name: MILLENNIUM PHYSICIAN GROUP, LLC
  • Facility Address: 20205 CORTEZ BLVD UNIT A
    BROOKSVILLE, FL
    ZIP 34601
  • Facility Phone: (352) 796-5303
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KELLEN GOWER
  • NPI Number: 1073131702
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D1013625
LAB Type Physician Office
Facility Name MILLENNIUM PHYSICIAN GROUP, LLC
Street 20205 CORTEZ BLVD UNIT A
City BROOKSVILLE
State FL
ZIP 34601
Phone 3527965303
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/12/2025
Certificate Expiration Date 6/11/2027
Facility Type Physician Office
Lab Director KELLEN GOWER

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This page was last updated on: 5/18/2026