24D2279169 CLIA NUMBER - DIAMOND LAKE CLINIC

Laboratory Demographics

  • CLIA Code: 24D2279169
  • Facility Name: DIAMOND LAKE CLINIC
  • Facility Address: 5939 PORTLAND AVE S
    MINNEAPOLIS, MN
    ZIP 55417
  • Facility Phone: 612 869-4444
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHUKWUEMEKA A. ANYAKE
  • NPI Number: 1740669498
  • Taxonomy: 261QH0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D2279169
LAB Type Physician Office
Facility Name DIAMOND LAKE CLINIC
Street 5939 PORTLAND AVE S
City MINNEAPOLIS
State MN
ZIP 55417
Phone 612 869-4444
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/30/2025
Certificate Expiration Date 3/29/2027
Facility Type Physician Office
Lab Director CHUKWUEMEKA A. ANYAKE

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