23D0866065 CLIA NUMBER - BASE DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 23D0866065
  • Facility Name: BASE DERMATOLOGY
  • Facility Address: 26400 W 12 MILE ROAD SUITE 180
    SOUTHFIELD, MI
    ZIP 48034
  • Facility Phone: 248 355-5047
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: BRYAN D. SOFEN
  • NPI Number: 1902672652
  • Taxonomy: 207ND0101X - Dermatology

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 23D0866065
LAB Type Physician Office
Facility Name BASE DERMATOLOGY
Street 26400 W 12 MILE ROAD SUITE 180
City SOUTHFIELD
State MI
ZIP 48034
Phone 248 355-5047
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 11/9/2024
Certificate Expiration Date 11/8/2026
Facility Type Physician Office
Lab Director BRYAN D. SOFEN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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