24D2047643 CLIA NUMBER - DERMATOLOGY PROFESSIONALS

Laboratory Demographics

  • CLIA Code: 24D2047643
  • Facility Name: DERMATOLOGY PROFESSIONALS
  • Facility Address: 15167 EDGEWOOD DRIVE SUITE 200
    BAXTER, MN
    ZIP 56425
  • Facility Phone: 218 454-3065
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: PAUL B. LUNDSTROM
  • NPI Number: 1306196548
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D2047643
LAB Type Physician Office
Facility Name DERMATOLOGY PROFESSIONALS
Street 15167 EDGEWOOD DRIVE SUITE 200
City BAXTER
State MN
ZIP 56425
Phone 218 454-3065
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 9/12/2024
Certificate Expiration Date 9/11/2026
Facility Type Physician Office
Lab Director PAUL B. LUNDSTROM

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