03D1101676 CLIA NUMBER - LAKESIDE INTERNAL MEDICINE, PLLC

Laboratory Demographics

  • CLIA Code: 03D1101676
  • Facility Name: LAKESIDE INTERNAL MEDICINE, PLLC
  • Facility Address: 10450 E RIGGS RD, STE 110
    SUN LAKES, AZ
    ZIP 85248
  • Facility Phone: 480 895-7600
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PHILIP L. KU
  • NPI Number: 1063854420
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 03D1101676
LAB Type Physician Office
Facility Name LAKESIDE INTERNAL MEDICINE, PLLC
Street 10450 E RIGGS RD, STE 110
City SUN LAKES
State AZ
ZIP 85248
Phone 480 895-7600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/2/2025
Certificate Expiration Date 7/1/2027
Facility Type Physician Office
Lab Director PHILIP L. KU

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