23D2110027 CLIA NUMBER - EASTLAKE CARDIOVASCULAR, PC

Laboratory Demographics

  • CLIA Code: 23D2110027
  • Facility Name: EASTLAKE CARDIOVASCULAR, PC
  • Facility Address: 25990 KELLY ROAD SUITE 3
    ROSEVILLE, MI
    ZIP 48066
  • Facility Phone: 586 498-0440
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: THOMAS P. DAVIS
  • NPI Number: 1982657474
  • Taxonomy: 207RC0000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D2110027
LAB Type Physician Office
Facility Name EASTLAKE CARDIOVASCULAR, PC
Street 25990 KELLY ROAD SUITE 3
City ROSEVILLE
State MI
ZIP 48066
Phone 586 498-0440
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/8/2024
Certificate Expiration Date 3/7/2026
Facility Type Physician Office
Lab Director THOMAS P. DAVIS

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