23D0904212 CLIA NUMBER - MYMICHIGAN FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 23D0904212
  • Facility Name: MYMICHIGAN FAMILY MEDICINE
  • Facility Address: 121 N PINE RIVER STREET
    ITHACA, MI
    ZIP 48847
  • Facility Phone: 989 875-5111
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL A. STACK
  • NPI Number: 1376580175
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 23D0904212
LAB Type Physician Office
Facility Name MYMICHIGAN FAMILY MEDICINE
Street 121 N PINE RIVER STREET
City ITHACA
State MI
ZIP 48847
Phone 989 875-5111
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/11/2025
Certificate Expiration Date 8/10/2027
Facility Type Physician Office
Lab Director MICHAEL A. STACK

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