52D0712457 CLIA NUMBER - SAMIR MULLICK, MDSC

Laboratory Demographics

  • CLIA Code: 52D0712457
  • Facility Name: SAMIR MULLICK, MDSC
  • Facility Address: 4267 W FOND DU LAC AVE
    MILWAUKEE, WI
    ZIP 53216
  • Facility Phone: (414) 873-3440
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. SAMIR MULLICK
  • NPI Number: 1235182221
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 52D0712457
LAB Type Physician Office
Facility Name SAMIR MULLICK, MDSC
Street 4267 W FOND DU LAC AVE
City MILWAUKEE
State WI
ZIP 53216
Phone 4148733440
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 9/21/2024
Certificate Expiration Date 9/20/2026
Facility Type Physician Office
Lab Director DR. SAMIR MULLICK

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This page was last updated on: 5/15/2026