15D1053470 CLIA NUMBER - SOUTHLAKE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 15D1053470
  • Facility Name: SOUTHLAKE PEDIATRICS
  • Facility Address: 99 E 86TH AVE, STE D
    MERRILLVILLE, IN
    ZIP 46410
  • Facility Phone: 219 736-9690
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: HALAH HAMZEH
  • NPI Number: 1629272729
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 15D1053470
LAB Type Physician Office
Facility Name SOUTHLAKE PEDIATRICS
Street 99 E 86TH AVE, STE D
City MERRILLVILLE
State IN
ZIP 46410
Phone 219 736-9690
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/25/2024
Certificate Expiration Date 4/24/2026
Facility Type Physician Office
Lab Director HALAH HAMZEH

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