23D0991111 CLIA NUMBER - LEGEND HEALTH SHENANDOAH CLINIC

Laboratory Demographics

  • CLIA Code: 23D0991111
  • Facility Name: LEGEND HEALTH SHENANDOAH CLINIC
  • Facility Address: 909 W MAPLE ROAD
    CLAWSON, MI
    ZIP 48017
  • Facility Phone: 248 435-2028
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RONALD ROTHENBERG
  • NPI Number: 1043394877
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D0991111
LAB Type Physician Office
Facility Name LEGEND HEALTH SHENANDOAH CLINIC
Street 909 W MAPLE ROAD
City CLAWSON
State MI
ZIP 48017
Phone 248 435-2028
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/22/2024
Certificate Expiration Date 3/21/2026
Facility Type Physician Office
Lab Director RONALD ROTHENBERG

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