10D2313217 CLIA NUMBER - MILLENNIUM PHYSICIAN GROUP, LLC

Laboratory Demographics

  • CLIA Code: 10D2313217
  • Facility Name: MILLENNIUM PHYSICIAN GROUP, LLC
  • Facility Address: 126 DEL PRADO BLVD - STE 103
    CAPE CORAL, FL
    ZIP 33909
  • Facility Phone: 941 787-7665
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JERRY LANZA
  • NPI Number: 1467115436
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2313217
LAB Type Physician Office
Facility Name MILLENNIUM PHYSICIAN GROUP, LLC
Street 126 DEL PRADO BLVD - STE 103
City CAPE CORAL
State FL
ZIP 33909
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 10/28/2024
Certificate Expiration Date 10/27/2026
Facility Type Physician Office
Lab Director JERRY LANZA

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