15D0357342 CLIA NUMBER - MICHAEL J O'CONNELL DO/CLEVELAND ROAD FAMILY PRA

Laboratory Demographics

  • CLIA Code: 15D0357342
  • Facility Name: MICHAEL J O'CONNELL DO/CLEVELAND ROAD FAMILY PRA
  • Facility Address: 17960 CLEVELAND RD
    SOUTH BEND, IN
    ZIP 46635
  • Facility Phone: 574 287-7205
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL J. O CONNELL
  • NPI Number: 1083691885
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D0357342
LAB Type Physician Office
Facility Name MICHAEL J O'CONNELL DO/CLEVELAND ROAD FAMILY PRA
Street 17960 CLEVELAND RD
City SOUTH BEND
State IN
ZIP 46635
Phone 574 287-7205
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director MICHAEL J. O CONNELL

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