23D0884152 CLIA NUMBER - BIO MEDICAL APP GREAT LAKES DIALYSIS

Laboratory Demographics

CLIA Number: 23D0884152

Facility Name: BIO MEDICAL APP GREAT LAKES DIALYSIS

Facility Address:
992 S MONROE STREET
MONROE, MI
ZIP 48161
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Facility Phone Number: 734 457-4189

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1184739922

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	23D0884152
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	BIO MEDICAL APP GREAT LAKES DIALYSIS
Street	992 S MONROE STREET
City	MONROE
State	MI
ZIP	48161
Phone	734 457-4189
CertificateType	4
CertificateEffectiveDate	3/26/2024
CertificateExpirationDate	3/25/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024