19D1044569 CLIA NUMBER - MICHAEL W DOLE MD

Laboratory Demographics

  • CLIA Code: 19D1044569
  • Facility Name: MICHAEL W DOLE MD
  • Facility Address: 5408 PROVINE PLACE
    ALEXANDRIA, LA
    ZIP 71303
  • Facility Phone: 318 449-8333
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL DOLE
  • NPI Number: 1750364121
  • Taxonomy: 208100000X - Physical Medicine & Rehabilitation

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CLIA Record

Field Name Field Value
CLIA Number 19D1044569
LAB Type Physician Office
Facility Name MICHAEL W DOLE MD
Street 5408 PROVINE PLACE
City ALEXANDRIA
State LA
ZIP 71303
Phone 318 449-8333
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/9/2023
Certificate Expiration Date 11/8/2025
Facility Type Physician Office
Lab Director MICHAEL DOLE

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