10D2175305 CLIA NUMBER - MILLENNIUM PHYSICIAN GROUP LLC

Laboratory Demographics

  • CLIA Code: 10D2175305
  • Facility Name: MILLENNIUM PHYSICIAN GROUP LLC
  • Facility Address: 2299 9TH AVE N - SUITE 1A
    SAINT PETERSBURG, FL
    ZIP 33713
  • Facility Phone: 941 787-7665
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RYAN L. BAKER
  • NPI Number: 1952073546
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2175305
LAB Type Physician Office
Facility Name MILLENNIUM PHYSICIAN GROUP LLC
Street 2299 9TH AVE N - SUITE 1A
City SAINT PETERSBURG
State FL
ZIP 33713
Phone 941 787-7665
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/19/2023
Certificate Expiration Date 11/18/2025
Facility Type Physician Office
Lab Director RYAN L. BAKER

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