23D1037086 CLIA NUMBER - SILVER LAKE FAMILY PRACTICE PLLC

Laboratory Demographics

  • CLIA Code: 23D1037086
  • Facility Name: SILVER LAKE FAMILY PRACTICE PLLC
  • Facility Address: 1100 TORREY ROAD SUITE 300
    FENTON, MI
    ZIP 48430
  • Facility Phone: 810 714-7369
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SUSAN A. WILLIS
  • NPI Number: 1124208608
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D1037086
LAB Type Physician Office
Facility Name SILVER LAKE FAMILY PRACTICE PLLC
Street 1100 TORREY ROAD SUITE 300
City FENTON
State MI
ZIP 48430
Phone 810 714-7369
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/15/2025
Certificate Expiration Date 2/14/2027
Facility Type Physician Office
Lab Director SUSAN A. WILLIS

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