23D0371782 CLIA NUMBER - WEST BLOOMFIELD INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 23D0371782
  • Facility Name: WEST BLOOMFIELD INTERNAL MEDICINE
  • Facility Address: 6014 WEST MAPLE ROAD
    WEST BLOOMFIELD, MI
    ZIP 48322
  • Facility Phone: 248 855-7453
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAMES BRAGMAN
  • NPI Number: 1699883272
  • Taxonomy: 174400000X - Specialist

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/21/2023
Certificate Expiration Date 8/20/2025
Facility Type Physician Office
Lab Director JAMES BRAGMAN

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This page was last updated on: 3/20/2025