24D2108690 CLIA NUMBER - ODAM MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 24D2108690
  • Facility Name: ODAM MEDICAL GROUP
  • Facility Address: 6014 LAKELAND AVE N
    CRYSTAL, MN
    ZIP 55428
  • Facility Phone: 612 871-2312
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROBERT LARBI-ODAM
  • NPI Number: 1902392525
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D2108690
LAB Type Physician Office
Facility Name ODAM MEDICAL GROUP
Street 6014 LAKELAND AVE N
City CRYSTAL
State MN
ZIP 55428
Phone 612 871-2312
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/9/2024
Certificate Expiration Date 2/8/2026
Facility Type Physician Office
Lab Director ROBERT LARBI-ODAM

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