23D0376943 CLIA NUMBER - TRESTLEWOOD PEDIATRICS

Laboratory Demographics

  • CLIA Code: 23D0376943
  • Facility Name: TRESTLEWOOD PEDIATRICS
  • Facility Address: 5082 LOVERS LANE
    PORTAGE, MI
    ZIP 49002
  • Facility Phone: 269 381-0118
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANTHONY J. VAN ES
  • NPI Number: 1407068695
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 23D0376943
LAB Type Physician Office
Facility Name TRESTLEWOOD PEDIATRICS
Street 5082 LOVERS LANE
City PORTAGE
State MI
ZIP 49002
Phone 269 381-0118
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 ANTHONY J. VAN ES

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