23D0959302 CLIA NUMBER - PDI GRAND RAPIDS

Laboratory Demographics

  • CLIA Code: 23D0959302
  • Facility Name: PDI GRAND RAPIDS
  • Facility Address: 801 CHERRY STREET, SE
    GRAND RAPIDS, MI
    ZIP 49506
  • Facility Phone: 616 458-5100
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: ANDREW J. KRUTUL
  • NPI Number: 1508827023
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 23D0959302
LAB Type Other
Facility Name PDI GRAND RAPIDS
Street 801 CHERRY STREET, SE
City GRAND RAPIDS
State MI
ZIP 49506
Phone 616 458-5100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/8/2025
Certificate Expiration Date 4/7/2027
Facility Type Other
Lab Director ANDREW J. KRUTUL

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