45D1041545 CLIA NUMBER - IFTHEKAR UNNISSA MD

Laboratory Demographics

  • CLIA Code: 45D1041545
  • Facility Name: IFTHEKAR UNNISSA MD
  • Facility Address: 21372 PROVINCIAL BLVD
    KATY, TX
    ZIP 77450
  • Facility Phone: 281 578-9766
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: IFTHEKAR UNNISSA MD
  • NPI Number: 1265443493
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 45D1041545
LAB Type Physician Office
Facility Name IFTHEKAR UNNISSA MD
Street 21372 PROVINCIAL BLVD
City KATY
State TX
ZIP 77450
Phone 281 578-9766
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/6/2025
Certificate Expiration Date 6/5/2027
Facility Type Physician Office
Lab Director IFTHEKAR UNNISSA MD

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