23D1055303 CLIA NUMBER - MINUTECLINIC DIAGNOSTIC OF MICHIGAN, PC (#8262)

Laboratory Demographics

CLIA Number: 23D1055303

Facility Name: MINUTECLINIC DIAGNOSTIC OF MICHIGAN, PC (#8262)

Facility Address:
39350 NINE MILE ROAD
NORTHVILLE, MI
ZIP 48167
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Facility Phone Number: 401 770-5422

Facility Type: Health Fair

Certificate Type: Waiver

NPI Number: 1902848617

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	23D1055303
LAB Type	Health Fair
Facility Name	MINUTECLINIC DIAGNOSTIC OF MICHIGAN, PC (#8262)
Street	39350 NINE MILE ROAD
City	NORTHVILLE
State	MI
ZIP	48167
Phone	401 770-5422
CertificateType	4
CertificateEffectiveDate	6/14/2022
CertificateExpirationDate	6/13/2024
FacilityType	Waiver

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