23D0896978 CLIA NUMBER - HENRY FORD DEIGHTON FAMILY MEDICINE - SOUTHFIELD

Laboratory Demographics

  • CLIA Code: 23D0896978
  • Facility Name: HENRY FORD DEIGHTON FAMILY MEDICINE - SOUTHFIELD
  • Facility Address: 22250 PROVIDENCE DRIVE SUITE 500
    SOUTHFIELD, MI
    ZIP 48075
  • Facility Phone: 248 849-3441
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAMILA N. TAYLOR
  • NPI Number: 1043476955
  • Taxonomy: 332BX2000X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 23D0896978
LAB Type Physician Office
Facility Name HENRY FORD DEIGHTON FAMILY MEDICINE - SOUTHFIELD
Street 22250 PROVIDENCE DRIVE SUITE 500
City SOUTHFIELD
State MI
ZIP 48075
Phone 248 849-3441
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/12/2025
Certificate Expiration Date 7/11/2027
Facility Type Physician Office
Lab Director JAMILA N. TAYLOR

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