23D2245670 CLIA NUMBER - PROMED PRIMARY CARE PLLC

Laboratory Demographics

  • CLIA Code: 23D2245670
  • Facility Name: PROMED PRIMARY CARE PLLC
  • Facility Address: 19041 E 12 MILE ROAD SUITE 103
    ROSEVILLE, MI
    ZIP 48066
  • Facility Phone: 248 632-8182
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KYRIACOU MANOLIS
  • NPI Number: 1336808864
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D2245670
LAB Type Physician Office
Facility Name PROMED PRIMARY CARE PLLC
Street 19041 E 12 MILE ROAD SUITE 103
City ROSEVILLE
State MI
ZIP 48066
Phone 248 632-8182
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/15/2023
Certificate Expiration Date 12/14/2025
Facility Type Physician Office
Lab Director KYRIACOU MANOLIS

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