15D1084723 CLIA NUMBER - PORTAGE DIALYSIS

Laboratory Demographics

  • CLIA Code: 15D1084723
  • Facility Name: PORTAGE DIALYSIS
  • Facility Address: 5823 US HWY 6
    PORTAGE, IN
    ZIP 46368
  • Facility Phone: (219) 764-0564
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: MAHER AJAM
  • NPI Number: 1588822688
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D1084723
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name PORTAGE DIALYSIS
Street 5823 US HWY 6
City PORTAGE
State IN
ZIP 46368
Phone 2197640564
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/2/2026
Certificate Expiration Date 6/1/2028
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director MAHER AJAM

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This page was last updated on: 5/18/2026