03D1098941 CLIA NUMBER - SHAM M VENGURLEKAR MD PC

Laboratory Demographics

CLIA Number: 03D1098941

Facility Name: SHAM M VENGURLEKAR MD PC

Facility Address:
7010 E CHAUNCEY LN, STE 215
PHOENIX, AZ
ZIP 85054
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Facility Phone Number: 480 314-2288

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1366401721

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	03D1098941
LAB Type	Physician Office
Facility Name	SHAM M VENGURLEKAR MD PC
Street	7010 E CHAUNCEY LN, STE 215
City	PHOENIX
State	AZ
ZIP	85054
Phone	480 314-2288
CertificateType	4
CertificateEffectiveDate	5/1/2023
CertificateExpirationDate	4/30/2025
FacilityType	Waiver

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