10D1096066 CLIA NUMBER - MILLENNIUM PHYSICIAN GROUP LLC

Laboratory Demographics

  • CLIA Code: 10D1096066
  • Facility Name: MILLENNIUM PHYSICIAN GROUP LLC
  • Facility Address: 13815 TAMIAMI TRL S
    NORTH PORT, FL
    ZIP 34287
  • Facility Phone: 941 235-3447
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. ROBERT GUTIRREZ
  • NPI Number: 1114699881
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D1096066
LAB Type Physician Office
Facility Name MILLENNIUM PHYSICIAN GROUP LLC
Street 13815 TAMIAMI TRL S
City NORTH PORT
State FL
ZIP 34287
Phone 941 235-3447
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/25/2025
Certificate Expiration Date 2/24/2027
Facility Type Physician Office
Lab Director DR. ROBERT GUTIRREZ

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