15D0925904 CLIA NUMBER - PORTER PHYICIAN SERVICES LLC PORTAGE MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 15D0925904
  • Facility Name: PORTER PHYICIAN SERVICES LLC PORTAGE MEDICAL GROUP
  • Facility Address: 3630 WILLOWCREEK RD
    PORTAGE, IN
    ZIP 46368
  • Facility Phone: 219 364-3700
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. KAJAL PURANIK
  • NPI Number: 1457566309
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D0925904
LAB Type Physician Office
Facility Name PORTER PHYICIAN SERVICES LLC PORTAGE MEDICAL GROUP
Street 3630 WILLOWCREEK RD
City PORTAGE
State IN
ZIP 46368
Phone 219 364-3700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/23/2024
Certificate Expiration Date 7/22/2026
Facility Type Physician Office
Lab Director DR. KAJAL PURANIK

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