52D0391078 CLIA NUMBER - FOREFRONT DERMATOLOGY, SC

Laboratory Demographics

  • CLIA Code: 52D0391078
  • Facility Name: FOREFRONT DERMATOLOGY, SC
  • Facility Address: 10303 N PORT WASHINGTON RD, STE 101
    MEQUON, WI
    ZIP 53092
  • Facility Phone: 262 240-0440
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. ANTHONY BONFIGLIO
  • NPI Number: 1225473713
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 52D0391078
LAB Type Physician Office
Facility Name FOREFRONT DERMATOLOGY, SC
Street 10303 N PORT WASHINGTON RD, STE 101
City MEQUON
State WI
ZIP 53092
Phone 262 240-0440
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 9/13/2024
Certificate Expiration Date 9/12/2026
Facility Type Physician Office
Lab Director DR. ANTHONY BONFIGLIO

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