24D2117007 CLIA NUMBER - LAKEVILLE DIALYSIS

Laboratory Demographics

  • CLIA Code: 24D2117007
  • Facility Name: LAKEVILLE DIALYSIS
  • Facility Address: 20184 HERITAGE DRIVE
    LAKEVILLE, MN
    ZIP 55044
  • Facility Phone: 952 985-5438
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: OLIVER T. PHAN
  • NPI Number: 1467801860
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D2117007
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name LAKEVILLE DIALYSIS
Street 20184 HERITAGE DRIVE
City LAKEVILLE
State MN
ZIP 55044
Phone 952 985-5438
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/8/2024
Certificate Expiration Date 8/7/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director OLIVER T. PHAN

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