23D0721269 CLIA NUMBER - BROOKVILLE PEDIATRIC AND INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 23D0721269
  • Facility Name: BROOKVILLE PEDIATRIC AND INTERNAL MEDICINE
  • Facility Address: 1200 56TH STREET SW
    WYOMING, MI
    ZIP 49509
  • Facility Phone: 616 243-5707
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: REBECCA L. MAKI
  • NPI Number: 1346200847
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 23D0721269
LAB Type Physician Office
Facility Name BROOKVILLE PEDIATRIC AND INTERNAL MEDICINE
Street 1200 56TH STREET SW
City WYOMING
State MI
ZIP 49509
Phone 616 243-5707
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/28/2025
Certificate Expiration Date 6/27/2027
Facility Type Physician Office
Lab Director REBECCA L. MAKI

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