23D0364243 CLIA NUMBER - PHYSICIAN HEALTHCARE NETWORK, PC

Laboratory Demographics

  • CLIA Code: 23D0364243
  • Facility Name: PHYSICIAN HEALTHCARE NETWORK, PC
  • Facility Address: 4190 24TH AVENUE
    FORT GRATIOT, MI
    ZIP 48059
  • Facility Phone: 810 989-7788
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DANIEL SOUPHIS
  • NPI Number: 1639385784
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 23D0364243
LAB Type Physician Office
Facility Name PHYSICIAN HEALTHCARE NETWORK, PC
Street 4190 24TH AVENUE
City FORT GRATIOT
State MI
ZIP 48059
Phone 810 989-7788
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/2/2025
Certificate Expiration Date 1/1/2027
Facility Type Physician Office
Lab Director DANIEL SOUPHIS

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