15D0910366 CLIA NUMBER - RANDALL DERMATOLOGY PC

Laboratory Demographics

  • CLIA Code: 15D0910366
  • Facility Name: RANDALL DERMATOLOGY PC
  • Facility Address: 124 SAGAMORE PKWY W
    WEST LAFAYETTE, IN
    ZIP 47906
  • Facility Phone: 765 463-6722
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: JOHN K. RANDALL
  • NPI Number: 1245340488
  • Taxonomy: 207N00000X - Dermatology

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 15D0910366
LAB Type Physician Office
Facility Name RANDALL DERMATOLOGY PC
Street 124 SAGAMORE PKWY W
City WEST LAFAYETTE
State IN
ZIP 47906
Phone 765 463-6722
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 1/30/2025
Certificate Expiration Date 1/29/2027
Facility Type Physician Office
Lab Director JOHN K. RANDALL

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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