24D2274067 CLIA NUMBER - DERMATOLOGY PROFESSIONALS

Laboratory Demographics

  • CLIA Code: 24D2274067
  • Facility Name: DERMATOLOGY PROFESSIONALS
  • Facility Address: 1749 SE 2ND AVE
    GRAND RAPIDS, MN
    ZIP 55744
  • Facility Phone: 218 454-7546
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: PAUL LUNDSTROM
  • NPI Number: 1356714182
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D2274067
LAB Type Physician Office
Facility Name DERMATOLOGY PROFESSIONALS
Street 1749 SE 2ND AVE
City GRAND RAPIDS
State MN
ZIP 55744
Phone 218 454-7546
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 12/23/2024
Certificate Expiration Date 12/22/2026
Facility Type Physician Office
Lab Director PAUL LUNDSTROM

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