36D0999663 CLIA NUMBER - PEDIATRIC PRACTICE INC

Laboratory Demographics

  • CLIA Code: 36D0999663
  • Facility Name: PEDIATRIC PRACTICE INC
  • Facility Address: 14701 DETROIT AVENUE SUITE 730
    LAKEWOOD, OH
    ZIP 44107
  • Facility Phone: 216 529-7780
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GOVIN BASKAR
  • NPI Number: 1831307800
  • Taxonomy: 208000000X - Pediatrics

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 36D0999663
LAB Type Physician Office
Facility Name PEDIATRIC PRACTICE INC
Street 14701 DETROIT AVENUE SUITE 730
City LAKEWOOD
State OH
ZIP 44107
Phone 216 529-7780
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/6/2024
Certificate Expiration Date 7/5/2026
Facility Type Physician Office
Lab Director GOVIN BASKAR

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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