23D2301290 CLIA NUMBER - COORDINATED MEDICAL I PLLC

Laboratory Demographics

CLIA Number: 23D2301290

Facility Name: COORDINATED MEDICAL I PLLC

Facility Address:
39555 ORCHARD HILL PLACE SUITE 600
NOVI, MI
ZIP 48375
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Facility Phone Number: 833 633-1295

Facility Type: Other - PROVIDER HOME VISITS

Certificate Type: Waiver

NPI Number: 1053019679

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	23D2301290
LAB Type	Other - PROVIDER HOME VISITS
Facility Name	COORDINATED MEDICAL I PLLC
Street	39555 ORCHARD HILL PLACE SUITE 600
City	NOVI
State	MI
ZIP	48375
Phone	833 633-1295
CertificateType	4
CertificateEffectiveDate	3/25/2024
CertificateExpirationDate	3/24/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024