23D2102656 CLIA NUMBER - PRISM MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 23D2102656
  • Facility Name: PRISM MEDICAL GROUP
  • Facility Address: 50 W BIG BEAVER SUITE 190
    BLOOMFIELD HILLS, MI
    ZIP 48304
  • Facility Phone: 248 997-7000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JONATHAN D. COPELAND
  • NPI Number: 1750535779
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D2102656
LAB Type Physician Office
Facility Name PRISM MEDICAL GROUP
Street 50 W BIG BEAVER SUITE 190
City BLOOMFIELD HILLS
State MI
ZIP 48304
Phone 248 997-7000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/28/2025
Certificate Expiration Date 9/27/2027
Facility Type Physician Office
Lab Director JONATHAN D. COPELAND

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