15D1035173 CLIA NUMBER - DR MARY TILAK PC

Laboratory Demographics

  • CLIA Code: 15D1035173
  • Facility Name: DR MARY TILAK PC
  • Facility Address: 9410 CALUMET AVE SUITE 101
    MUNSTER, IN
    ZIP 46321
  • Facility Phone: 219 922-8051
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARY TILAK
  • NPI Number: 1003096900
  • Taxonomy: 207RB0002X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D1035173
LAB Type Physician Office
Facility Name DR MARY TILAK PC
Street 9410 CALUMET AVE SUITE 101
City MUNSTER
State IN
ZIP 46321
Phone 219 922-8051
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/22/2024
Certificate Expiration Date 12/21/2026
Facility Type Physician Office
Lab Director MARY TILAK

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