23D1007029 CLIA NUMBER - DAVID FIVENSON, MD, DERMATOLOGY, PLLC

Laboratory Demographics

  • CLIA Code: 23D1007029
  • Facility Name: DAVID FIVENSON, MD, DERMATOLOGY, PLLC
  • Facility Address: 3200 W LIBERTY ROAD SUITE C5
    ANN ARBOR, MI
    ZIP 48103
  • Facility Phone: 734 222-9630
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DAVID P. FIVENSON
  • NPI Number: 1235193525
  • Taxonomy: 207NI0002X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 23D1007029
LAB Type Physician Office
Facility Name DAVID FIVENSON, MD, DERMATOLOGY, PLLC
Street 3200 W LIBERTY ROAD SUITE C5
City ANN ARBOR
State MI
ZIP 48103
Phone 734 222-9630
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 12/6/2024
Certificate Expiration Date 12/5/2026
Facility Type Physician Office
Lab Director DAVID P. FIVENSON

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