15D2001341 CLIA NUMBER - LAKE - PORTER MEDICAL GROUP PORTER PHYSICIAN SERVICES LLC

Laboratory Demographics

  • CLIA Code: 15D2001341
  • Facility Name: LAKE - PORTER MEDICAL GROUP PORTER PHYSICIAN SERVICES LLC
  • Facility Address: 336 US HIGHWAY 30 STE A&B
    VALPARAISO, IN
    ZIP 46383
  • Facility Phone: 219 464-7430
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. MICHAEL MIROCHNA
  • NPI Number: 1972694669
  • Taxonomy: 208G00000X - Thoracic Surgery (Cardiothoracic Vascular Surgery)

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CLIA Record

Field Name Field Value
CLIA Number 15D2001341
LAB Type Physician Office
Facility Name LAKE - PORTER MEDICAL GROUP PORTER PHYSICIAN SERVICES LLC
Street 336 US HIGHWAY 30 STE A&B
City VALPARAISO
State IN
ZIP 46383
Phone 219 464-7430
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/17/2023
Certificate Expiration Date 12/16/2025
Facility Type Physician Office
Lab Director DR. MICHAEL MIROCHNA

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