03D2072438 CLIA NUMBER - RICHARD M KOOTMAN MD PC

Laboratory Demographics

  • CLIA Code: 03D2072438
  • Facility Name: RICHARD M KOOTMAN MD PC
  • Facility Address: 13943 NORTH 91ST AVE BLDG G
    PEORIA, AZ
    ZIP 85381
  • Facility Phone: 623 561-1995
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RICHARD M. KOOTMAN
  • NPI Number: 1700896149
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 03D2072438
LAB Type Physician Office
Facility Name RICHARD M KOOTMAN MD PC
Street 13943 NORTH 91ST AVE BLDG G
City PEORIA
State AZ
ZIP 85381
Phone 623 561-1995
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/30/2024
Certificate Expiration Date 1/29/2026
Facility Type Physician Office
Lab Director RICHARD M. KOOTMAN

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