23D0372415 CLIA NUMBER - WATERFORD FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 23D0372415
  • Facility Name: WATERFORD FAMILY MEDICINE
  • Facility Address: 2590 ELIZABETH LAKE ROAD
    WATERFORD, MI
    ZIP 48328
  • Facility Phone: 248 738-5500
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. ESA M. ALI
  • NPI Number: 1689224818
  • Taxonomy: 1223G0001X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 23D0372415
LAB Type Physician Office
Facility Name WATERFORD FAMILY MEDICINE
Street 2590 ELIZABETH LAKE ROAD
City WATERFORD
State MI
ZIP 48328
Phone 248 738-5500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director DR. ESA M. ALI

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