52D0390279 CLIA NUMBER - GERALD L IGNACE INDIAN HEALTH CENTER, INC

Laboratory Demographics

  • CLIA Code: 52D0390279
  • Facility Name: GERALD L IGNACE INDIAN HEALTH CENTER, INC
  • Facility Address: 930 W HISTORIC MITCHELL ST
    MILWAUKEE, WI
    ZIP 53204
  • Facility Phone: 414 383-9526
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Microscopy
  • Lab Director: DR. MUSTANSIR MAJEED
  • NPI Number: 1710498514
  • Taxonomy: 1223G0001X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 52D0390279
LAB Type Federally Qualified Health Center
Facility Name GERALD L IGNACE INDIAN HEALTH CENTER, INC
Street 930 W HISTORIC MITCHELL ST
City MILWAUKEE
State WI
ZIP 53204
Phone 414 383-9526
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Federally Qualified Health Center
Lab Director DR. MUSTANSIR MAJEED

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This page was last updated on: 6/4/2025