23D0712306 CLIA NUMBER - WESTERN WAYNE PHYSICIANS PLC

Laboratory Demographics

  • CLIA Code: 23D0712306
  • Facility Name: WESTERN WAYNE PHYSICIANS PLC
  • Facility Address: 8338 ALLEN ROAD SUITE 101
    ALLEN PARK, MI
    ZIP 48101
  • Facility Phone: 313 386-5500
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROBERT J. JACKSON
  • NPI Number: 1629263520
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D0712306
LAB Type Physician Office
Facility Name WESTERN WAYNE PHYSICIANS PLC
Street 8338 ALLEN ROAD SUITE 101
City ALLEN PARK
State MI
ZIP 48101
Phone 313 386-5500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/6/2025
Certificate Expiration Date 1/5/2027
Facility Type Physician Office
Lab Director ROBERT J. JACKSON

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