23D0380898 CLIA NUMBER - MICHIGAN UROLOGICAL CLINIC

Laboratory Demographics

  • CLIA Code: 23D0380898
  • Facility Name: MICHIGAN UROLOGICAL CLINIC
  • Facility Address: 4047 E HILLS COURT SE
    GRAND RAPIDS, MI
    ZIP 49546
  • Facility Phone: 616 956-9577
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: KENNETH F. SHOCKLEY
  • NPI Number: 1376586164
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 23D0380898
LAB Type Physician Office
Facility Name MICHIGAN UROLOGICAL CLINIC
Street 4047 E HILLS COURT SE
City GRAND RAPIDS
State MI
ZIP 49546
Phone 616 956-9577
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director KENNETH F. SHOCKLEY

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