23D2059316 CLIA NUMBER - UROLOGIC CONSULTANTS - MICHIGAN INSTITUTE OF UROLOGY

Laboratory Demographics

  • CLIA Code: 23D2059316
  • Facility Name: UROLOGIC CONSULTANTS - MICHIGAN INSTITUTE OF UROLOGY
  • Facility Address: 25 MICHIGAN STREET NE SUITE 300
    GRAND RAPIDS, MI
    ZIP 49503
  • Facility Phone: 616 459-4171
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: PHILLIP G. WISE
  • NPI Number: 1598865735
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 23D2059316
LAB Type Physician Office
Facility Name UROLOGIC CONSULTANTS - MICHIGAN INSTITUTE OF UROLOGY
Street 25 MICHIGAN STREET NE SUITE 300
City GRAND RAPIDS
State MI
ZIP 49503
Phone 616 459-4171
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 5/21/2023
Certificate Expiration Date 5/20/2025
Facility Type Physician Office
Lab Director PHILLIP G. WISE

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This page was last updated on: 3/20/2025