52D0395048 CLIA NUMBER - DOUSMAN CLINIC SC

Laboratory Demographics

  • CLIA Code: 52D0395048
  • Facility Name: DOUSMAN CLINIC SC
  • Facility Address: 124 SIEGLER ST
    GREEN BAY, WI
    ZIP 54303
  • Facility Phone: 920 494-9661
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. MARK JENSON
  • NPI Number: 1265634331
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 52D0395048
LAB Type Physician Office
Facility Name DOUSMAN CLINIC SC
Street 124 SIEGLER ST
City GREEN BAY
State WI
ZIP 54303
Phone 920 494-9661
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/24/2025
Certificate Expiration Date 1/23/2027
Facility Type Physician Office
Lab Director DR. MARK JENSON

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