23D2077798 CLIA NUMBER - PORTAGE PHYSICIAN PRACTICES, INC DBA UP MEDICAL GROUP- PORTAGE EXPRESS CARE

Laboratory Demographics

  • CLIA Code: 23D2077798
  • Facility Name: PORTAGE PHYSICIAN PRACTICES, INC DBA UP MEDICAL GROUP- PORTAGE EXPRESS CARE
  • Facility Address: 921 W SHARON AVENUE
    HOUGHTON, MI
    ZIP 49931
  • Facility Phone: 906 483-1435
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: PETIO V. KOTOV
  • NPI Number: 1619304615
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 23D2077798
LAB Type Community Clinic
Facility Name PORTAGE PHYSICIAN PRACTICES, INC DBA UP MEDICAL GROUP- PORTAGE EXPRESS CARE
Street 921 W SHARON AVENUE
City HOUGHTON
State MI
ZIP 49931
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 Community Clinic
Lab Director PETIO V. KOTOV

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