23D0371782 CLIA NUMBER - WEST BLOOMFIELD INTERNAL MEDICINE

Laboratory Demographics

CLIA Number: 23D0371782

Facility Name: WEST BLOOMFIELD INTERNAL MEDICINE

Facility Address:
6014 WEST MAPLE ROAD
WEST BLOOMFIELD, MI
ZIP 48322
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Facility Phone Number: 248 855-7453

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1699883272

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	23D0371782
LAB Type	Physician Office
Facility Name	WEST BLOOMFIELD INTERNAL MEDICINE
Street	6014 WEST MAPLE ROAD
City	WEST BLOOMFIELD
State	MI
ZIP	48322
Phone	248 855-7453
CertificateType	4
CertificateEffectiveDate	8/21/2023
CertificateExpirationDate	8/20/2025
FacilityType	Waiver

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