23D0928522 CLIA NUMBER - NOVI DIALYSIS

Laboratory Demographics

CLIA Number: 23D0928522

Facility Name: NOVI DIALYSIS

Facility Address:
27150 PROVIDENCE PARKWAY SUITE A
NOVI, MI
ZIP 48374
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Facility Phone Number: 248 449-4215

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1073574596

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	23D0928522
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	NOVI DIALYSIS
Street	27150 PROVIDENCE PARKWAY SUITE A
City	NOVI
State	MI
ZIP	48374
Phone	248 449-4215
CertificateType	4
CertificateEffectiveDate	5/20/2023
CertificateExpirationDate	5/19/2025
FacilityType	Waiver

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