23D1074300 CLIA NUMBER - MARY LEE

Laboratory Demographics

  • CLIA Code: 23D1074300
  • Facility Name: MARY LEE
  • Facility Address: 5799 W MAPLE ROAD SUITE 163
    WEST BLOOMFIELD, MI
    ZIP 48322
  • Facility Phone: 248 419-5111
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARY LEE
  • NPI Number: 1932180817
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D1074300
LAB Type Physician Office
Facility Name MARY LEE
Street 5799 W MAPLE ROAD SUITE 163
City WEST BLOOMFIELD
State MI
ZIP 48322
Phone 248 419-5111
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/26/2025
Certificate Expiration Date 9/25/2027
Facility Type Physician Office
Lab Director MARY LEE

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