23D2119278 CLIA NUMBER - MEMORIAL HEALTHCARE DIABETES AND ENDOCRINOLOGY

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Laboratory Demographics

CLIA Number: 23D2119278

Facility Name: MEMORIAL HEALTHCARE DIABETES AND ENDOCRINOLOGY

Facility Address:
802 W KING STREET SUITE E
OWOSSO, MI
ZIP 48867
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Facility Phone Number: 989 729-4131

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1609073709

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	23D2119278
LAB Type	Physician Office
Facility Name	MEMORIAL HEALTHCARE DIABETES AND ENDOCRINOLOGY
Street	802 W KING STREET SUITE E
City	OWOSSO
State	MI
ZIP	48867
Phone	989 729-4131
CertificateType	4
CertificateEffectiveDate	9/22/2022
CertificateExpirationDate	9/21/2024
FacilityType	Waiver

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