23D1005530 CLIA NUMBER - PEDIATRIC & ADOLESCENT CENTER

Laboratory Demographics

  • CLIA Code: 23D1005530
  • Facility Name: PEDIATRIC & ADOLESCENT CENTER
  • Facility Address: 15555 NORTHLINE ROAD
    SOUTHGATE, MI
    ZIP 48195
  • Facility Phone: 734 285-3090
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DINESH NAYAK
  • NPI Number: 1235284233
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 23D1005530
LAB Type Physician Office
Facility Name PEDIATRIC & ADOLESCENT CENTER
Street 15555 NORTHLINE ROAD
City SOUTHGATE
State MI
ZIP 48195
Phone 734 285-3090
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2025
Certificate Expiration Date 9/30/2027
Facility Type Physician Office
Lab Director DINESH NAYAK

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