07D0989083 CLIA NUMBER - INTERNAL MEDICINE GROUP LLC

Laboratory Demographics

  • CLIA Code: 07D0989083
  • Facility Name: INTERNAL MEDICINE GROUP LLC
  • Facility Address: ONE TOWNE PARK PLAZA
    NORWICH, CT
    ZIP 06360
  • Facility Phone: 860 887-0010
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: HANNA KACKIELO MD
  • NPI Number: 1770617367
  • Taxonomy: 207RG0300X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 07D0989083
LAB Type Physician Office
Facility Name INTERNAL MEDICINE GROUP LLC
Street ONE TOWNE PARK PLAZA
City NORWICH
State CT
ZIP 06360
Phone 860 887-0010
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/17/2025
Certificate Expiration Date 7/16/2027
Facility Type Physician Office
Lab Director HANNA KACKIELO MD

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