23D0956761 CLIA NUMBER - PEDIATRIC & ADOLESCENT CLINIC OF MI

Laboratory Demographics

  • CLIA Code: 23D0956761
  • Facility Name: PEDIATRIC & ADOLESCENT CLINIC OF MI
  • Facility Address: 3850 PELHAM STREET
    DEARBORN, MI
    ZIP 48124
  • Facility Phone: 313 562-9500
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LORETTE HADDAD
  • NPI Number: 1538568696
  • Taxonomy: 207YP0228X - Otolaryngology

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CLIA Record

Field Name Field Value
CLIA Number 23D0956761
LAB Type Physician Office
Facility Name PEDIATRIC & ADOLESCENT CLINIC OF MI
Street 3850 PELHAM STREET
City DEARBORN
State MI
ZIP 48124
Phone 313 562-9500
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 LORETTE HADDAD

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