23D1000468 CLIA NUMBER - HENRY FORD EXCEL PRIMARY CARE - LATHRUP VILLAGE

Laboratory Demographics

  • CLIA Code: 23D1000468
  • Facility Name: HENRY FORD EXCEL PRIMARY CARE - LATHRUP VILLAGE
  • Facility Address: 18161 W 12 MILE ROAD, SUITE 2
    LATHRUP VILLAGE, MI
    ZIP 48076
  • Facility Phone: 248 552-1200
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MANHAL W. TOBIA
  • NPI Number: 1174799530
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 23D1000468
LAB Type Physician Office
Facility Name HENRY FORD EXCEL PRIMARY CARE - LATHRUP VILLAGE
Street 18161 W 12 MILE ROAD, SUITE 2
City LATHRUP VILLAGE
State MI
ZIP 48076
Phone 248 552-1200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/17/2024
Certificate Expiration Date 6/16/2026
Facility Type Physician Office
Lab Director MANHAL W. TOBIA

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