10D0955541 CLIA NUMBER - MACKOUL PEDIATRICS

Laboratory Demographics

  • CLIA Code: 10D0955541
  • Facility Name: MACKOUL PEDIATRICS
  • Facility Address: 206 SE 16TH PLACE
    CAPE CORAL, FL
    ZIP 33990
  • Facility Phone: 941 573-2001
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAVID A. MACKOUL
  • NPI Number: 1659389948
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 10D0955541
LAB Type Physician Office
Facility Name MACKOUL PEDIATRICS
Street 206 SE 16TH PLACE
City CAPE CORAL
State FL
ZIP 33990
Phone 941 573-2001
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/4/2025
Certificate Expiration Date 1/3/2027
Facility Type Physician Office
Lab Director DAVID A. MACKOUL

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