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23D2104372 CLIA NUMBER - PREMISE HEALTH OF MICHIGAN MEDICAL, P C

Laboratory Demographics

CLIA Number: 23D2104372

Facility Name: PREMISE HEALTH OF MICHIGAN MEDICAL, P C

Facility Address:
300 WEST 13 MILE ROAD
MADISON HEIGHTS, MI
ZIP 48071
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Facility Phone Number: 248 837-2626

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1669146726

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name Field Value
CLIA Number 23D2104372
LAB Type Physician Office
Facility Name PREMISE HEALTH OF MICHIGAN MEDICAL, P C
Street 300 WEST 13 MILE ROAD
City MADISON HEIGHTS
State MI
ZIP 48071
Phone 248 837-2626
CertificateType 4
CertificateEffectiveDate 11/3/2023
CertificateExpirationDate 11/2/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024