15D2104060 CLIA NUMBER - DUPONT PEDIATRICS

Laboratory Demographics

  • CLIA Code: 15D2104060
  • Facility Name: DUPONT PEDIATRICS
  • Facility Address: 2510 EAST DUPONT RD SUITE 200
    FORT WAYNE, IN
    ZIP 46825
  • Facility Phone: 260 432-4913
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: OSITA V. EZEAKUDO
  • NPI Number: 1447634449
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 15D2104060
LAB Type Physician Office
Facility Name DUPONT PEDIATRICS
Street 2510 EAST DUPONT RD SUITE 200
City FORT WAYNE
State IN
ZIP 46825
Phone 260 432-4913
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/27/2023
Certificate Expiration Date 10/26/2025
Facility Type Physician Office
Lab Director OSITA V. EZEAKUDO

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