23D0370384 CLIA NUMBER - CORNERSTONE PEDIATRICS

Laboratory Demographics

CLIA Number: 23D0370384

Facility Name: CORNERSTONE PEDIATRICS

Facility Address:
25319 LITTLE MACK
ST CLAIR SHORES, MI
ZIP 48081
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Facility Phone Number: 810 443-4950

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1316350192

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	23D0370384
LAB Type	Physician Office
Facility Name	CORNERSTONE PEDIATRICS
Street	25319 LITTLE MACK
City	ST CLAIR SHORES
State	MI
ZIP	48081
Phone	810 443-4950
CertificateType	4
CertificateEffectiveDate	6/17/2023
CertificateExpirationDate	6/16/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024