23D2067097 CLIA NUMBER - MICHIGAN ENDOSCOPY CENTER AT PROVIDENCE PARK

Laboratory Demographics

  • CLIA Code: 23D2067097
  • Facility Name: MICHIGAN ENDOSCOPY CENTER AT PROVIDENCE PARK
  • Facility Address: 47601 GRAND RIVER AVE, STE D-110
    NOVI, MI
    ZIP 48374
  • Facility Phone: 248 865-6555
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: MARK S. DEVORE
  • NPI Number: 1629075106
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 23D2067097
LAB Type Ambulatory Surgery Center
Facility Name MICHIGAN ENDOSCOPY CENTER AT PROVIDENCE PARK
Street 47601 GRAND RIVER AVE, STE D-110
City NOVI
State MI
ZIP 48374
Phone 248 865-6555
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/9/2023
Certificate Expiration Date 10/8/2025
Facility Type Ambulatory Surgery Center
Lab Director MARK S. DEVORE

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