52D0394605 CLIA NUMBER - TC FAM MED SHAWANO

Laboratory Demographics

  • CLIA Code: 52D0394605
  • Facility Name: TC FAM MED SHAWANO
  • Facility Address: 100 COUNTY ROAD B
    SHAWANO, WI
    ZIP 54166
  • Facility Phone: 920 830-5869
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. ANGELA D. DIVJAK

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CLIA Record

Field Name Field Value
CLIA Number 52D0394605
LAB Type Physician Office
Facility Name TC FAM MED SHAWANO
Street 100 COUNTY ROAD B
City SHAWANO
State WI
ZIP 54166
Phone 920 830-5869
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/21/2023
Certificate Expiration Date 9/20/2025
Facility Type Physician Office
Lab Director DR. ANGELA D. DIVJAK

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