24D2109333 CLIA NUMBER - TWIN CITIES PHYSICIAN PROFESSIONAL CORP

Laboratory Demographics

  • CLIA Code: 24D2109333
  • Facility Name: TWIN CITIES PHYSICIAN PROFESSIONAL CORP
  • Facility Address: 1415 LILAC DR N, SUITE 190
    GOLDEN VALLEY, MN
    ZIP 55422
  • Facility Phone: 763 267-8701
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: LORA E. SHIRAR
  • NPI Number: 1992176499
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D2109333
LAB Type Practitioner Other
Facility Name TWIN CITIES PHYSICIAN PROFESSIONAL CORP
Street 1415 LILAC DR N, SUITE 190
City GOLDEN VALLEY
State MN
ZIP 55422
Phone 763 267-8701
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/23/2024
Certificate Expiration Date 2/22/2026
Facility Type Practitioner Other
Lab Director LORA E. SHIRAR

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