23D0956754 CLIA NUMBER - PERRY MLK MEDICAL CENTER, PC

Laboratory Demographics

  • CLIA Code: 23D0956754
  • Facility Name: PERRY MLK MEDICAL CENTER, PC
  • Facility Address: 673 MARTIN LUTHER KING BLVD NORTH
    PONTIAC, MI
    ZIP 48342
  • Facility Phone: 248 334-4961
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BRYAN SWILLEY DO
  • NPI Number: 1407942394
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 23D0956754
LAB Type Physician Office
Facility Name PERRY MLK MEDICAL CENTER, PC
Street 673 MARTIN LUTHER KING BLVD NORTH
City PONTIAC
State MI
ZIP 48342
Phone 248 334-4961
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/4/2025
Certificate Expiration Date 2/3/2027
Facility Type Physician Office
Lab Director BRYAN SWILLEY DO

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