52D0390271 CLIA NUMBER - WISCONSIN AVENUE DIALYSIS

Laboratory Demographics

  • CLIA Code: 52D0390271
  • Facility Name: WISCONSIN AVENUE DIALYSIS
  • Facility Address: 3801 W WISCONSIN AVE
    MILWAUKEE, WI
    ZIP 53208
  • Facility Phone: 414 937-8240
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. AHMED M. MALIK
  • NPI Number: 1144285917
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 52D0390271
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name WISCONSIN AVENUE DIALYSIS
Street 3801 W WISCONSIN AVE
City MILWAUKEE
State WI
ZIP 53208
Phone 414 937-8240
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. AHMED M. MALIK

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This page was last updated on: 3/20/2025