23D2189063 CLIA NUMBER - RECOVERY MOBILE CLINIC

Laboratory Demographics

  • CLIA Code: 23D2189063
  • Facility Name: RECOVERY MOBILE CLINIC
  • Facility Address: 7111 DIXIE HIGHWAY #142
    CLARKSTON, MI
    ZIP 48346
  • Facility Phone: 248 563-5735
  • Facility Type: Other - MOBILE CLINIC
  • Facility Type: Waiver
  • Lab Director: IRA MICKELSON
  • NPI Number: 1902431653
  • Taxonomy: 363LA2100X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 23D2189063
LAB Type Other - MOBILE CLINIC
Facility Name RECOVERY MOBILE CLINIC
Street 7111 DIXIE HIGHWAY #142
City CLARKSTON
State MI
ZIP 48346
Phone 248 563-5735
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/27/2024
Certificate Expiration Date 7/26/2026
Facility Type Other - MOBILE CLINIC
Lab Director IRA MICKELSON

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