10D1026705 CLIA NUMBER - MILLENNIUM PHYSICIAN GROUP LLC

Laboratory Demographics

CLIA Number: 10D1026705

Facility Name: MILLENNIUM PHYSICIAN GROUP LLC

Facility Address:
9500 BONITA BEACH ROAD #201
BONITA SPRINGS, FL
ZIP 34135
Get Directions

Facility Phone Number: 941 764-1880

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1487174421

Taxonomy: 261QA0600X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D1026705
LAB Type	Physician Office
Facility Name	MILLENNIUM PHYSICIAN GROUP LLC
Street	9500 BONITA BEACH ROAD #201
City	BONITA SPRINGS
State	FL
ZIP	34135
Phone	941 764-1880
CertificateType	4
CertificateEffectiveDate	6/14/2022
CertificateExpirationDate	6/13/2024
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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