23D2318853 CLIA NUMBER - LOON LAKE PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 23D2318853
  • Facility Name: LOON LAKE PRIMARY CARE
  • Facility Address: 1545 N WIXOM ROAD
    WIXOM, MI
    ZIP 48393
  • Facility Phone: 248 833-6343
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PAUL SHABOU
  • NPI Number: 1326890666
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D2318853
LAB Type Physician Office
Facility Name LOON LAKE PRIMARY CARE
Street 1545 N WIXOM ROAD
City WIXOM
State MI
ZIP 48393
Phone 248 833-6343
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/19/2025
Certificate Expiration Date 2/18/2027
Facility Type Physician Office
Lab Director PAUL SHABOU

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