36D2043146 CLIA NUMBER - KOUBA DERMATOLOG MOHS LAB - WAUSEON

Laboratory Demographics

  • CLIA Code: 36D2043146
  • Facility Name: KOUBA DERMATOLOG MOHS LAB - WAUSEON
  • Facility Address: 1090 NORTH SHOOP AVENUE
    WAUSEON, OH
    ZIP 43567
  • Facility Phone: 419 479-5792
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: DAVID J. KOUBA
  • NPI Number: 1003231994
  • Taxonomy: 1223G0001X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 36D2043146
LAB Type Physician Office
Facility Name KOUBA DERMATOLOG MOHS LAB - WAUSEON
Street 1090 NORTH SHOOP AVENUE
City WAUSEON
State OH
ZIP 43567
Phone 419 479-5792
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 10/25/2024
Certificate Expiration Date 10/24/2026
Facility Type Physician Office
Lab Director DAVID J. KOUBA

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