15D2309128 CLIA NUMBER - BEACON MEDICAL GROUP INFECTIOUS DISEASE

Laboratory Demographics

  • CLIA Code: 15D2309128
  • Facility Name: BEACON MEDICAL GROUP INFECTIOUS DISEASE
  • Facility Address: 621 MEMORIAL DRIVE, STE 624
    SOUTH BEND, IN
    ZIP 46601
  • Facility Phone: 574 647-8177
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARJORIE DAOUD
  • NPI Number: 1205887817
  • Taxonomy: 207RR0500X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D2309128
LAB Type Physician Office
Facility Name BEACON MEDICAL GROUP INFECTIOUS DISEASE
Street 621 MEMORIAL DRIVE, STE 624
City SOUTH BEND
State IN
ZIP 46601
Phone 574 647-8177
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/9/2024
Certificate Expiration Date 8/8/2026
Facility Type Physician Office
Lab Director MARJORIE DAOUD

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