23D0691773 CLIA NUMBER - V M D PRIMARY PROVIDERS EASTERN MICHIGAN, P C

Laboratory Demographics

  • CLIA Code: 23D0691773
  • Facility Name: V M D PRIMARY PROVIDERS EASTERN MICHIGAN, P C
  • Facility Address: 620 N PONTIAC TRAIL
    WALLED LAKE, MI
    ZIP 48390
  • Facility Phone: 248 624-4511
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GARY HOLLANDER
  • NPI Number: 1790901072
  • Taxonomy: 363A00000X - Physician Assistant

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CLIA Record

Field Name Field Value
CLIA Number 23D0691773
LAB Type Physician Office
Facility Name V M D PRIMARY PROVIDERS EASTERN MICHIGAN, P C
Street 620 N PONTIAC TRAIL
City WALLED LAKE
State MI
ZIP 48390
Phone 248 624-4511
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/16/2025
Certificate Expiration Date 2/15/2027
Facility Type Physician Office
Lab Director GARY HOLLANDER

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