23D2051988 CLIA NUMBER - INTERNAL MEDICINE AND AESTHETICS

Laboratory Demographics

  • CLIA Code: 23D2051988
  • Facility Name: INTERNAL MEDICINE AND AESTHETICS
  • Facility Address: 6505 CONSTITUTION BOULEVARD
    PORTAGE, MI
    ZIP 49024
  • Facility Phone: 269 599-8140
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROCKELLE D. ROGERS
  • NPI Number: 1780442103
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D2051988
LAB Type Physician Office
Facility Name INTERNAL MEDICINE AND AESTHETICS
Street 6505 CONSTITUTION BOULEVARD
City PORTAGE
State MI
ZIP 49024
Phone 269 599-8140
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/11/2024
Certificate Expiration Date 4/10/2026
Facility Type Physician Office
Lab Director ROCKELLE D. ROGERS

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