23D1004406 CLIA NUMBER - WAYNE STATE UNIVERSITY PHYSICIAN GROUP

Laboratory Demographics

  • CLIA Code: 23D1004406
  • Facility Name: WAYNE STATE UNIVERSITY PHYSICIAN GROUP
  • Facility Address: 3901 CHRYSLER SERVICE DRIVE
    DETROIT, MI
    ZIP 48201
  • Facility Phone: 313 993-6732
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ALIREZA AMIRSADRI
  • NPI Number: 1285129221
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D1004406
LAB Type Physician Office
Facility Name WAYNE STATE UNIVERSITY PHYSICIAN GROUP
Street 3901 CHRYSLER SERVICE DRIVE
City DETROIT
State MI
ZIP 48201
Phone 313 993-6732
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/26/2024
Certificate Expiration Date 9/25/2026
Facility Type Physician Office
Lab Director ALIREZA AMIRSADRI

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