23D0723416 CLIA NUMBER - LAKE MICHIGAN NEPHROLOGY

Laboratory Demographics

  • CLIA Code: 23D0723416
  • Facility Name: LAKE MICHIGAN NEPHROLOGY
  • Facility Address: 3800 HOLLYWOOD ROAD SUITE 104
    SAINT JOSEPH, MI
    ZIP 49085
  • Facility Phone: 269 428-0819
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: KATHERINE KWON
  • NPI Number: 1821201500
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 23D0723416
LAB Type Physician Office
Facility Name LAKE MICHIGAN NEPHROLOGY
Street 3800 HOLLYWOOD ROAD SUITE 104
City SAINT JOSEPH
State MI
ZIP 49085
Phone 269 428-0819
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 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director KATHERINE KWON

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