10D2275308 CLIA NUMBER - MILLENNIUM PHYSICIAN GROUP, LLC

Laboratory Demographics

  • CLIA Code: 10D2275308
  • Facility Name: MILLENNIUM PHYSICIAN GROUP, LLC
  • Facility Address: 18699 TAMIAMI TRAIL
    NORTH PORT, FL
    ZIP 34287
  • Facility Phone: 941 787-7665
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LEE ANTON
  • NPI Number: 1215690102
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2275308
LAB Type Physician Office
Facility Name MILLENNIUM PHYSICIAN GROUP, LLC
Street 18699 TAMIAMI TRAIL
City NORTH PORT
State FL
ZIP 34287
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 1/19/2025
Certificate Expiration Date 1/18/2027
Facility Type Physician Office
Lab Director LEE ANTON

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