15D2058128 CLIA NUMBER - MICHIANA ADULT MEDICAL SPECIALIST

Laboratory Demographics

  • CLIA Code: 15D2058128
  • Facility Name: MICHIANA ADULT MEDICAL SPECIALIST
  • Facility Address: 212 W EDISON RD
    MISHAWAKA, IN
    ZIP 46545
  • Facility Phone: 574 222-2359
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ALEXANDER C. GATZIMOS
  • NPI Number: 1154663763
  • Taxonomy: 207RG0300X - Internal Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 15D2058128
LAB Type Physician Office
Facility Name MICHIANA ADULT MEDICAL SPECIALIST
Street 212 W EDISON RD
City MISHAWAKA
State IN
ZIP 46545
Phone 574 222-2359
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 5/30/2025
Certificate Expiration Date 5/29/2027
Facility Type Physician Office
Lab Director ALEXANDER C. GATZIMOS

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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