36D0887661 CLIA NUMBER - KETTERING HEALTH MEDICAL GROUP INTERNAL MEDICINE CENTER

Laboratory Demographics

  • CLIA Code: 36D0887661
  • Facility Name: KETTERING HEALTH MEDICAL GROUP INTERNAL MEDICINE CENTER
  • Facility Address: 2115 LEITER ROAD, SUITE 300
    MIAMISBURG, OH
    ZIP 45342
  • Facility Phone: 937 384-6800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANDREW MOREN
  • NPI Number: 1487936795
  • Taxonomy: 208600000X - Surgery

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CLIA Record

Field Name Field Value
CLIA Number 36D0887661
LAB Type Physician Office
Facility Name KETTERING HEALTH MEDICAL GROUP INTERNAL MEDICINE CENTER
Street 2115 LEITER ROAD, SUITE 300
City MIAMISBURG
State OH
ZIP 45342
Phone 937 384-6800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/1/2024
Certificate Expiration Date 10/31/2026
Facility Type Physician Office
Lab Director ANDREW MOREN

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