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

Laboratory Demographics

  • CLIA Code: 23D1048524
  • Facility Name: COREWELL HEALTH CONCIERGE MEDICINE - 4069 LAKE DR SE
  • Facility Address: 4069 LAKE DRIVE SE SUITE 113
    GRAND RAPIDS, MI
    ZIP 49546
  • Facility Phone: 616 267-8880
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SAM J. GIOVANNUCCI
  • NPI Number: 1407313802
  • Taxonomy: 261QA1903X - Clinic/Center

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/5/2023
Certificate Expiration Date 12/4/2025
Facility Type Physician Office
Lab Director SAM J. GIOVANNUCCI

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