15D0357900 CLIA NUMBER - LUTHERAN MEDICAL GROUP LLC-D/B/A LUTHERAN HEALTH PHYSICIANS

Laboratory Demographics

  • CLIA Code: 15D0357900
  • Facility Name: LUTHERAN MEDICAL GROUP LLC-D/B/A LUTHERAN HEALTH PHYSICIANS
  • Facility Address: 800 BROADWAY, SUITE 100
    FORT WAYNE, IN
    ZIP 46802
  • Facility Phone: 260 425-2630
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: IBAD FAROOQUI
  • NPI Number: 1023060472
  • Taxonomy: 282N00000X - General Acute Care Hospital

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CLIA Record

Field Name Field Value
CLIA Number 15D0357900
LAB Type Physician Office
Facility Name LUTHERAN MEDICAL GROUP LLC-D/B/A LUTHERAN HEALTH PHYSICIANS
Street 800 BROADWAY, SUITE 100
City FORT WAYNE
State IN
ZIP 46802
Phone 260 425-2630
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/30/2025
Certificate Expiration Date 1/29/2027
Facility Type Physician Office
Lab Director IBAD FAROOQUI

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