10D2023341 CLIA NUMBER - CONSTELLATION MEDICAL GROUP LLC

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Laboratory Demographics

CLIA Number: 10D2023341

Facility Name: CONSTELLATION MEDICAL GROUP LLC

Facility Address:
15600 NW 67 AVENUE STE 105
MIAMI LAKES, FL
ZIP 33014
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Facility Phone Number: 305 760-2525

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1225794852

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	10D2023341
LAB Type	Physician Office
Facility Name	CONSTELLATION MEDICAL GROUP LLC
Street	15600 NW 67 AVENUE STE 105
City	MIAMI LAKES
State	FL
ZIP	33014
Phone	305 760-2525
CertificateType	4
CertificateEffectiveDate	4/20/2023
CertificateExpirationDate	4/19/2025
FacilityType	Waiver

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