23D0367764 CLIA NUMBER - MEDICAL GROUP PRACTICE PC

Laboratory Demographics

  • CLIA Code: 23D0367764
  • Facility Name: MEDICAL GROUP PRACTICE PC
  • Facility Address: 9460 MIDDLEBELT ROAD
    LIVONIA, MI
    ZIP 48150
  • Facility Phone: 734 425-0780
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: WILLIAM PENN
  • NPI Number: 1801925201
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D0367764
LAB Type Physician Office
Facility Name MEDICAL GROUP PRACTICE PC
Street 9460 MIDDLEBELT ROAD
City LIVONIA
State MI
ZIP 48150
Phone 734 425-0780
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/2/2025
Certificate Expiration Date 6/1/2027
Facility Type Physician Office
Lab Director WILLIAM PENN

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