23D2180226 CLIA NUMBER - INTEGRATED CARE CLINICIANS LLC

Laboratory Demographics

  • CLIA Code: 23D2180226
  • Facility Name: INTEGRATED CARE CLINICIANS LLC
  • Facility Address: 989 UNIVERSITY DRIVE SUITES 107 & 108
    PONTIAC, MI
    ZIP 48342
  • Facility Phone: 248 818-1249
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: BARBRENE L. MAHLULI
  • NPI Number: 1013558386
  • Taxonomy: 261QM2800X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 23D2180226
LAB Type Comp. Outpatient Rehab Facility
Facility Name INTEGRATED CARE CLINICIANS LLC
Street 989 UNIVERSITY DRIVE SUITES 107 & 108
City PONTIAC
State MI
ZIP 48342
Phone 248 818-1249
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/10/2024
Certificate Expiration Date 3/9/2026
Facility Type Comp. Outpatient Rehab Facility
Lab Director BARBRENE L. MAHLULI

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