23D2111252 CLIA NUMBER - PREMIER NEUROLOGY & PAIN SPECIALISTS

Laboratory Demographics

  • CLIA Code: 23D2111252
  • Facility Name: PREMIER NEUROLOGY & PAIN SPECIALISTS
  • Facility Address: 15750 NORTHLINE ROAD
    SOUTHGATE, MI
    ZIP 48195
  • Facility Phone: 734 357-0505
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: FADI H. DELLY
  • NPI Number: 1992170187
  • Taxonomy: 208VP0014X - Pain Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D2111252
LAB Type Physician Office
Facility Name PREMIER NEUROLOGY & PAIN SPECIALISTS
Street 15750 NORTHLINE ROAD
City SOUTHGATE
State MI
ZIP 48195
Phone 734 357-0505
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/4/2024
Certificate Expiration Date 4/3/2026
Facility Type Physician Office
Lab Director FADI H. DELLY

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