23D0963736 CLIA NUMBER - CRYSTAL LAKE CLINIC PC

Laboratory Demographics

  • CLIA Code: 23D0963736
  • Facility Name: CRYSTAL LAKE CLINIC PC
  • Facility Address: 1975 STERLING DRIVE
    INTERLOCHEN, MI
    ZIP 49643
  • Facility Phone: 231 882-9661
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JACOB G. FLYNN
  • NPI Number: 1053780072
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D0963736
LAB Type Physician Office
Facility Name CRYSTAL LAKE CLINIC PC
Street 1975 STERLING DRIVE
City INTERLOCHEN
State MI
ZIP 49643
Phone 231 882-9661
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/3/2025
Certificate Expiration Date 9/2/2027
Facility Type Physician Office
Lab Director JACOB G. FLYNN

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