15D0870955 CLIA NUMBER - ACQUARO MEDICAL PRACTICE PC

Laboratory Demographics

  • CLIA Code: 15D0870955
  • Facility Name: ACQUARO MEDICAL PRACTICE PC
  • Facility Address: 7806 W JEFFERSON BLVD STE E
    FORT WAYNE, IN
    ZIP 46804
  • Facility Phone: 260 459-0087
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DOMINICK J. ACQUARO
  • NPI Number: 1437265584
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D0870955
LAB Type Physician Office
Facility Name ACQUARO MEDICAL PRACTICE PC
Street 7806 W JEFFERSON BLVD STE E
City FORT WAYNE
State IN
ZIP 46804
Phone 260 459-0087
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 DOMINICK J. ACQUARO

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