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23D1039356 CLIA NUMBER - V M D PRIMARY PROVIDERS EASTERN MICHIGAN, P C

Laboratory Demographics

CLIA Number: 23D1039356

Facility Name: V M D PRIMARY PROVIDERS EASTERN MICHIGAN, P C

Facility Address:
39475 LEWIS DRIVE SUITE 130
NOVI, MI
ZIP 48377
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Facility Phone Number: 248 374-0502

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1235456609

Taxonomy: 213ES0131X - Podiatrist

CLIA Record

Field Name Field Value
CLIA Number 23D1039356
LAB Type Physician Office
Facility Name V M D PRIMARY PROVIDERS EASTERN MICHIGAN, P C
Street 39475 LEWIS DRIVE SUITE 130
City NOVI
State MI
ZIP 48377
Phone 248 374-0502
CertificateType 4
CertificateEffectiveDate 4/12/2023
CertificateExpirationDate 4/11/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024