23D2182318 CLIA NUMBER - BLUE WATER INTERNAL MEDICINE PC

Laboratory Demographics

  • CLIA Code: 23D2182318
  • Facility Name: BLUE WATER INTERNAL MEDICINE PC
  • Facility Address: 1210 10TH AVENUE
    PORT HURON, MI
    ZIP 48060
  • Facility Phone: 810 662-3505
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EMAD DAHER
  • NPI Number: 1255967667
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D2182318
LAB Type Physician Office
Facility Name BLUE WATER INTERNAL MEDICINE PC
Street 1210 10TH AVENUE
City PORT HURON
State MI
ZIP 48060
Phone 810 662-3505
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/20/2024
Certificate Expiration Date 4/19/2026
Facility Type Physician Office
Lab Director EMAD DAHER

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