23D1048524 CLIA NUMBER - COREWELL HEALTH CONCIERGE MEDICINE - 4069 LAKE DR SE

Laboratory Demographics

CLIA Number: 23D1048524

Facility Name: COREWELL HEALTH CONCIERGE MEDICINE - 4069 LAKE DR SE

Facility Address:
4069 LAKE DRIVE SE SUITE 113
GRAND RAPIDS, MI
ZIP 49546
Get Directions

Facility Phone Number: 616 267-8880

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1407313802

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	23D1048524
LAB Type	Physician Office
Facility Name	COREWELL HEALTH CONCIERGE MEDICINE - 4069 LAKE DR SE
Street	4069 LAKE DRIVE SE SUITE 113
City	GRAND RAPIDS
State	MI
ZIP	49546
Phone	616 267-8880
CertificateType	4
CertificateEffectiveDate	12/5/2023
CertificateExpirationDate	12/4/2025
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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