23D0363900 CLIA NUMBER - MACOMB INTERNAL MEDICINE ASSOC PC

Laboratory Demographics

  • CLIA Code: 23D0363900
  • Facility Name: MACOMB INTERNAL MEDICINE ASSOC PC
  • Facility Address: 15520 19 MILE ROAD SUITE 480
    CLINTON TOWNSHIP, MI
    ZIP 48038
  • Facility Phone: 586 228-1010
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JOSEPH W. KAISER
  • NPI Number: 1770522716
  • Taxonomy: 251300000X - Local Education Agency (LEA)

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CLIA Record

Field Name Field Value
CLIA Number 23D0363900
LAB Type Physician Office
Facility Name MACOMB INTERNAL MEDICINE ASSOC PC
Street 15520 19 MILE ROAD SUITE 480
City CLINTON TOWNSHIP
State MI
ZIP 48038
Phone 586 228-1010
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 4/11/2024
Certificate Expiration Date 4/10/2026
Facility Type Physician Office
Lab Director JOSEPH W. KAISER

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