23D0897011 CLIA NUMBER - MYMICHIGAN INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 23D0897011
  • Facility Name: MYMICHIGAN INTERNAL MEDICINE
  • Facility Address: 295 MAPLE STREET SUITE 202
    TAWAS CITY, MI
    ZIP 48763
  • Facility Phone: 989 362-6108
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JORDAN N. QUILICO
  • NPI Number: 1164410841
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 23D0897011
LAB Type Physician Office
Facility Name MYMICHIGAN INTERNAL MEDICINE
Street 295 MAPLE STREET SUITE 202
City TAWAS CITY
State MI
ZIP 48763
Phone 989 362-6108
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/29/2025
Certificate Expiration Date 1/28/2027
Facility Type Physician Office
Lab Director JORDAN N. QUILICO

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