23D0960257 CLIA NUMBER - BROOKSIDE FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 23D0960257
  • Facility Name: BROOKSIDE FAMILY MEDICINE
  • Facility Address: 647 E 8TH ST
    TRAVERSE CITY, MI
    ZIP 49686
  • Facility Phone: 231 922-0400
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DEBRA K. GRAETZ
  • NPI Number: 1699957571
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D0960257
LAB Type Physician Office
Facility Name BROOKSIDE FAMILY MEDICINE
Street 647 E 8TH ST
City TRAVERSE CITY
State MI
ZIP 49686
Phone 231 922-0400
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 5/5/2023
Certificate Expiration Date 5/4/2025
Facility Type Physician Office
Lab Director DEBRA K. GRAETZ

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This page was last updated on: 3/20/2025