23D2275082 CLIA NUMBER - GRACE PEDIATRICS PC

Laboratory Demographics

  • CLIA Code: 23D2275082
  • Facility Name: GRACE PEDIATRICS PC
  • Facility Address: 44200 WOODWARD AVENUE SUITE 103
    PONTIAC, MI
    ZIP 48341
  • Facility Phone: 248 253-9600
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROY J. PULLUKAT
  • NPI Number: 1003482019
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 23D2275082
LAB Type Physician Office
Facility Name GRACE PEDIATRICS PC
Street 44200 WOODWARD AVENUE SUITE 103
City PONTIAC
State MI
ZIP 48341
Phone 248 253-9600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/17/2025
Certificate Expiration Date 1/16/2027
Facility Type Physician Office
Lab Director ROY J. PULLUKAT

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