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23D0363900 CLIA NUMBER - MACOMB INTERNAL MEDICINE ASSOC PC

Laboratory Demographics

CLIA Number: 23D0363900

Facility Name: MACOMB INTERNAL MEDICINE ASSOC PC

Facility Address:
15520 NINETEEN MILE ROAD SUITE 480
CLINTON TOWNSHIP, MI
ZIP 48038
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Facility Phone Number: 810 228-1010

Facility Type: Physician Office

Certificate Type: Microscopy
NPI Number: 1770522716

Taxonomy: 251300000X - Local Education Agency (LEA)
The term local education agency means a public board of education or other public authority legally constituted within a State to either provide administrative control or direction of, or perform a service function for public schools serving individuals ages 0 - 21 in a state, city, county, township, school district, or other political subdivision including a combination of school districts or counties recognized in a State as an administrative agency for its public schools. An LEA may provide, or employ professional who provide, services to children included in the Individuals with Disabilities Education Act (IDEA), such services may include, but are not limited to, such medical services as physical, occupational, and speech therapy.

CLIA Record

Field Name Field Value
CLIA Number 23D0363900
LAB Type Physician Office
Facility Name MACOMB INTERNAL MEDICINE ASSOC PC
Street 15520 NINETEEN MILE ROAD SUITE 480
City CLINTON TOWNSHIP
State MI
ZIP 48038
Phone 810 228-1010
CertificateType 3
CertificateEffectiveDate 4/11/2024
CertificateExpirationDate 4/10/2026
FacilityType PPMP

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