23D0370914 CLIA NUMBER - CENTER FOR PREVENTIVE MEDICINE

Laboratory Demographics

  • CLIA Code: 23D0370914
  • Facility Name: CENTER FOR PREVENTIVE MEDICINE
  • Facility Address: 20870 MACK AVENUE
    GROSSE POINTE, MI
    ZIP 48236
  • Facility Phone: 313 885-2334
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: STEPHENIE M. LUCAS
  • NPI Number: 1174719025
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D0370914
LAB Type Physician Office
Facility Name CENTER FOR PREVENTIVE MEDICINE
Street 20870 MACK AVENUE
City GROSSE POINTE
State MI
ZIP 48236
Phone 313 885-2334
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/11/2025
Certificate Expiration Date 6/10/2027
Facility Type Physician Office
Lab Director STEPHENIE M. LUCAS

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