10D2261587 CLIA NUMBER - FAMILY TREE MEDICAL GROUP II, PA

Laboratory Demographics

CLIA Number: 10D2261587

Facility Name: FAMILY TREE MEDICAL GROUP II, PA

Facility Address:
2201 NORTH BLVD WEST
DAVENPORT, FL
ZIP 33837
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Facility Phone Number: 407 970-2981

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1720727654

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	10D2261587
LAB Type	Physician Office
Facility Name	FAMILY TREE MEDICAL GROUP II, PA
Street	2201 NORTH BLVD WEST
City	DAVENPORT
State	FL
ZIP	33837
Phone	407 970-2981
CertificateType	4
CertificateEffectiveDate	6/2/2022
CertificateExpirationDate	6/1/2024
FacilityType	Waiver

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