23D2305100 CLIA NUMBER - DAVID A WIESE, PHD, MD

Laboratory Demographics

  • CLIA Code: 23D2305100
  • Facility Name: DAVID A WIESE, PHD, MD
  • Facility Address: 4068 LEGEND WOODS LANE NE
    GRAND RAPIDS, MI
    ZIP 49525
  • Facility Phone: 810 516-7216
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: DAVID A. WIESE
  • NPI Number: 1164788196
  • Taxonomy: 207L00000X - Anesthesiology

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CLIA Record

Field Name Field Value
CLIA Number 23D2305100
LAB Type Physician Office
Facility Name DAVID A WIESE, PHD, MD
Street 4068 LEGEND WOODS LANE NE
City GRAND RAPIDS
State MI
ZIP 49525
Phone 810 516-7216
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 3/10/2025
Certificate Expiration Date 3/9/2027
Facility Type Physician Office
Lab Director DAVID A. WIESE

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