14D1039929 CLIA NUMBER - MICHAEL E MANDIS MD LLC

Laboratory Demographics

  • CLIA Code: 14D1039929
  • Facility Name: MICHAEL E MANDIS MD LLC
  • Facility Address: 2236 VADALABENE DR, STE 2
    MARYVILLE, IL
    ZIP 62062
  • Facility Phone: 618 391-5540
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL E. MANDIS
  • NPI Number: 1821065764
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D1039929
LAB Type Physician Office
Facility Name MICHAEL E MANDIS MD LLC
Street 2236 VADALABENE DR, STE 2
City MARYVILLE
State IL
ZIP 62062
Phone 618 391-5540
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/26/2025
Certificate Expiration Date 4/25/2027
Facility Type Physician Office
Lab Director MICHAEL E. MANDIS

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