52D0390467 CLIA NUMBER - LAKESIDE OB/GYN, SC

Laboratory Demographics

  • CLIA Code: 52D0390467
  • Facility Name: LAKESIDE OB/GYN, SC
  • Facility Address: 2524 E WEBSTER PL #303
    MILWAUKEE, WI
    ZIP 53211
  • Facility Phone: 414 271-1116
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: KATHLEEN M. TREBIAN, MD
  • NPI Number: 1407898992
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 52D0390467
LAB Type Physician Office
Facility Name LAKESIDE OB/GYN, SC
Street 2524 E WEBSTER PL #303
City MILWAUKEE
State WI
ZIP 53211
Phone 414 271-1116
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 Physician Office
Lab Director KATHLEEN M. TREBIAN, MD

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