10D2058192 CLIA NUMBER - MILLENNIUM PHYSICIAN GROUP

Laboratory Demographics

  • CLIA Code: 10D2058192
  • Facility Name: MILLENNIUM PHYSICIAN GROUP
  • Facility Address: 606 BALD EAGLE DR STE 302
    MARCO ISLAND, FL
    ZIP 34145
  • Facility Phone: 941 764-1880
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PATRICIA POLING
  • NPI Number: 1871265561
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2058192
LAB Type Physician Office
Facility Name MILLENNIUM PHYSICIAN GROUP
Street 606 BALD EAGLE DR STE 302
City MARCO ISLAND
State FL
ZIP 34145
Phone 941 764-1880
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/1/2025
Certificate Expiration Date 4/30/2027
Facility Type Physician Office
Lab Director PATRICIA POLING

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