23D2077796 CLIA NUMBER - PORTAGE PHYSICIAN PRACTICES, INC DBA UP MEDICAL GROUP- PORTAGE EXPRESS CARE

Laboratory Demographics

  • CLIA Code: 23D2077796
  • Facility Name: PORTAGE PHYSICIAN PRACTICES, INC DBA UP MEDICAL GROUP- PORTAGE EXPRESS CARE
  • Facility Address: 56720 CALUMET AVENUE SUITE B
    CALUMET, MI
    ZIP 49913
  • Facility Phone: 906 483-1435
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PETIO V. KOTOV
  • NPI Number: 1164106910
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 23D2077796
LAB Type Physician Office
Facility Name PORTAGE PHYSICIAN PRACTICES, INC DBA UP MEDICAL GROUP- PORTAGE EXPRESS CARE
Street 56720 CALUMET AVENUE SUITE B
City CALUMET
State MI
ZIP 49913
Phone 906 483-1435
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/15/2024
Certificate Expiration Date 5/14/2026
Facility Type Physician Office
Lab Director PETIO V. KOTOV

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