23D1014883 CLIA NUMBER - FOREFRONT DERMATOLOGY, S C DBA LAKESHORE

Laboratory Demographics

  • CLIA Code: 23D1014883
  • Facility Name: FOREFRONT DERMATOLOGY, S C DBA LAKESHORE
  • Facility Address: 6225 PRAIRIE STREET
    NORTON SHORES, MI
    ZIP 49444
  • Facility Phone: (920) 663-9146
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: JASON B. VAN ITTERSUM
  • NPI Number: 1003356692
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 23D1014883
LAB Type Physician Office
Facility Name FOREFRONT DERMATOLOGY, S C DBA LAKESHORE
Street 6225 PRAIRIE STREET
City NORTON SHORES
State MI
ZIP 49444
Phone 9206639146
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 3/27/2026
Certificate Expiration Date 3/26/2028
Facility Type Physician Office
Lab Director JASON B. VAN ITTERSUM

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This page was last updated on: 6/29/2026