23D0363991 CLIA NUMBER - PEDIATRIC CLINIC

Laboratory Demographics

  • CLIA Code: 23D0363991
  • Facility Name: PEDIATRIC CLINIC
  • Facility Address: 35054 23 MILE ROAD BLDG B SUITE 101
    NEW BALTIMORE, MI
    ZIP 48047
  • Facility Phone: 586 725-2670
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KEVIN KUTSKILL
  • NPI Number: 1437254448
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 23D0363991
LAB Type Physician Office
Facility Name PEDIATRIC CLINIC
Street 35054 23 MILE ROAD BLDG B SUITE 101
City NEW BALTIMORE
State MI
ZIP 48047
Phone 586 725-2670
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/14/2025
Certificate Expiration Date 3/13/2027
Facility Type Physician Office
Lab Director KEVIN KUTSKILL

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