36D0656247 CLIA NUMBER - GRAND LAKE FAMILY PRACTICE & PEDIATRICS

Laboratory Demographics

CLIA Number: 36D0656247

Facility Name: GRAND LAKE FAMILY PRACTICE & PEDIATRICS

Facility Address:
801 PRO DRIVE STE D1
CELINA, OH
ZIP 45822
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Facility Phone Number: 419 738-4445

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1841576998

Taxonomy: 213E00000X - Podiatrist
A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy.

CLIA Record

Field Name	Field Value
CLIA Number	36D0656247
LAB Type	Physician Office
Facility Name	GRAND LAKE FAMILY PRACTICE & PEDIATRICS
Street	801 PRO DRIVE STE D1
City	CELINA
State	OH
ZIP	45822
Phone	419 738-4445
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024