23D2304470 CLIA NUMBER - BLOOM WELLNESS DIRECT PRIMARY CARE, PLLC

Laboratory Demographics

  • CLIA Code: 23D2304470
  • Facility Name: BLOOM WELLNESS DIRECT PRIMARY CARE, PLLC
  • Facility Address: 7112 HIGHLAND ROAD
    WATERFORD, MI
    ZIP 48327
  • Facility Phone: 248 509-0055
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BLERTA L. GAQI
  • NPI Number: 1447003108
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D2304470
LAB Type Physician Office
Facility Name BLOOM WELLNESS DIRECT PRIMARY CARE, PLLC
Street 7112 HIGHLAND ROAD
City WATERFORD
State MI
ZIP 48327
Phone 248 509-0055
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/14/2024
Certificate Expiration Date 5/13/2026
Facility Type Physician Office
Lab Director BLERTA L. GAQI

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