23D0367967 CLIA NUMBER - TRINITY HEALTH IHA MEDICAL GROUP PRIMARY CARE - FREEDOM

Laboratory Demographics

  • CLIA Code: 23D0367967
  • Facility Name: TRINITY HEALTH IHA MEDICAL GROUP PRIMARY CARE - FREEDOM
  • Facility Address: 20206 FARMINGTON RD
    LIVONIA, MI
    ZIP 48152
  • Facility Phone: 248 476-4724
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SAMUEL FAWAZ
  • NPI Number: 1184154544
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 23D0367967
LAB Type Physician Office
Facility Name TRINITY HEALTH IHA MEDICAL GROUP PRIMARY CARE - FREEDOM
Street 20206 FARMINGTON RD
City LIVONIA
State MI
ZIP 48152
Phone 248 476-4724
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/11/2024
Certificate Expiration Date 9/10/2026
Facility Type Physician Office
Lab Director SAMUEL FAWAZ

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