16D2108685 CLIA NUMBER - GRAND RIVER MEDICAL GROUP DERMATOLOGY

Laboratory Demographics

CLIA Number: 16D2108685

Facility Name: GRAND RIVER MEDICAL GROUP DERMATOLOGY

Facility Address:
3405 LAKERIDGE DRIVE
DUBUQUE, IA
ZIP 52001
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Facility Phone Number: 563 557-9111

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1568427524

Taxonomy: 207R00000X - Internal Medicine
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

CLIA Record

Field Name	Field Value
CLIA Number	16D2108685
LAB Type	Physician Office
Facility Name	GRAND RIVER MEDICAL GROUP DERMATOLOGY
Street	3405 LAKERIDGE DRIVE
City	DUBUQUE
State	IA
ZIP	52001
Phone	563 557-9111
CertificateType	3
CertificateEffectiveDate	2/9/2024
CertificateExpirationDate	2/8/2026
FacilityType	PPMP

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This page was last updated on: 4/23/2024