23D0961584 CLIA NUMBER - KAVITHA PONDURI, MD, PC

Laboratory Demographics

  • CLIA Code: 23D0961584
  • Facility Name: KAVITHA PONDURI, MD, PC
  • Facility Address: 34659 W MICHIGAN AVENUE
    WAYNE, MI
    ZIP 48184
  • Facility Phone: 734 722-2400
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KAVITHA PONDURI
  • NPI Number: 1679568315
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D0961584
LAB Type Physician Office
Facility Name KAVITHA PONDURI, MD, PC
Street 34659 W MICHIGAN AVENUE
City WAYNE
State MI
ZIP 48184
Phone 734 722-2400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/10/2025
Certificate Expiration Date 6/9/2027
Facility Type Physician Office
Lab Director KAVITHA PONDURI

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