23D2158636 CLIA NUMBER - PRIMECARE ON WIXOM

Laboratory Demographics

  • CLIA Code: 23D2158636
  • Facility Name: PRIMECARE ON WIXOM
  • Facility Address: 27250 WIXOM ROAD SUITE A
    NOVI, MI
    ZIP 48374
  • Facility Phone: (248) 294-1101
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: THEODORE W. SHIVELY
  • NPI Number: 1982103362
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D2158636
LAB Type Physician Office
Facility Name PRIMECARE ON WIXOM
Street 27250 WIXOM ROAD SUITE A
City NOVI
State MI
ZIP 48374
Phone 2482941101
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/4/2024
Certificate Expiration Date 12/3/2026
Facility Type Physician Office
Lab Director THEODORE W. SHIVELY

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This page was last updated on: 5/18/2026