36D2002611 CLIA NUMBER - KIDNEY CARE SPECIALISTS LLC

Laboratory Demographics

  • CLIA Code: 36D2002611
  • Facility Name: KIDNEY CARE SPECIALISTS LLC
  • Facility Address: 1362 EAST STROOP ROAD
    KETTERING, OH
    ZIP 45429
  • Facility Phone: 937 643-0015
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AHMAD IBRAHIM
  • NPI Number: 1144555939
  • Taxonomy: 207RN0300X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 36D2002611
LAB Type Physician Office
Facility Name KIDNEY CARE SPECIALISTS LLC
Street 1362 EAST STROOP ROAD
City KETTERING
State OH
ZIP 45429
Phone 937 643-0015
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/21/2024
Certificate Expiration Date 1/20/2026
Facility Type Physician Office
Lab Director AHMAD IBRAHIM

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