23D0966756 CLIA NUMBER - HENRY FORD ST JOHN HOSPITAL

Laboratory Demographics

  • CLIA Code: 23D0966756
  • Facility Name: HENRY FORD ST JOHN HOSPITAL
  • Facility Address: 25195 KELLY ROAD SUITE A
    ROSEVILLE, MI
    ZIP 48066
  • Facility Phone: 586 775-4594
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: VAMSHIDHAR D. GUDUGUNTLA
  • NPI Number: 1922088780
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 23D0966756
LAB Type Physician Office
Facility Name HENRY FORD ST JOHN HOSPITAL
Street 25195 KELLY ROAD SUITE A
City ROSEVILLE
State MI
ZIP 48066
Phone 586 775-4594
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/26/2023
Certificate Expiration Date 10/25/2025
Facility Type Physician Office
Lab Director VAMSHIDHAR D. GUDUGUNTLA

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