23D2296699 CLIA NUMBER - BRADLEY P BENGTSON, MD, PLLC

Laboratory Demographics

  • CLIA Code: 23D2296699
  • Facility Name: BRADLEY P BENGTSON, MD, PLLC
  • Facility Address: 2155 E PARIS AVENUE SE SUITE 100
    GRAND RAPIDS, MI
    ZIP 49546
  • Facility Phone: 616 303-3861
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BRADLEY P. BENGTSON
  • NPI Number: 1780648139
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D2296699
LAB Type Physician Office
Facility Name BRADLEY P BENGTSON, MD, PLLC
Street 2155 E PARIS AVENUE SE SUITE 100
City GRAND RAPIDS
State MI
ZIP 49546
Phone 616 303-3861
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/4/2024
Certificate Expiration Date 1/3/2026
Facility Type Physician Office
Lab Director BRADLEY P. BENGTSON

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