52D0394173 CLIA NUMBER - FOREFRONT DERMATOLOGY, SC

Laboratory Demographics

  • CLIA Code: 52D0394173
  • Facility Name: FOREFRONT DERMATOLOGY, SC
  • Facility Address: 109 WARREN ST STE 1
    BEAVER DAM, WI
    ZIP 53916
  • Facility Phone: 920 885-2622
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. KURT W. GRELCK
  • NPI Number: 1033484373
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 52D0394173
LAB Type Physician Office
Facility Name FOREFRONT DERMATOLOGY, SC
Street 109 WARREN ST STE 1
City BEAVER DAM
State WI
ZIP 53916
Phone 920 885-2622
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 1/6/2025
Certificate Expiration Date 1/5/2027
Facility Type Physician Office
Lab Director DR. KURT W. GRELCK

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