52D0861163 CLIA NUMBER - THEDACARE PHYSICIANS PEDIATRICS APPLETON

Laboratory Demographics

  • CLIA Code: 52D0861163
  • Facility Name: THEDACARE PHYSICIANS PEDIATRICS APPLETON
  • Facility Address: 2701 E ENTERPRISE AVE
    APPLETON, WI
    ZIP 54913
  • Facility Phone: 920 954-2551
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. ANDRE KRAINIK
  • NPI Number: 1356424683
  • Taxonomy: 332900000X - Non-Pharmacy Dispensing Site

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CLIA Record

Field Name Field Value
CLIA Number 52D0861163
LAB Type Physician Office
Facility Name THEDACARE PHYSICIANS PEDIATRICS APPLETON
Street 2701 E ENTERPRISE AVE
City APPLETON
State WI
ZIP 54913
Phone 920 954-2551
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/15/2024
Certificate Expiration Date 4/14/2026
Facility Type Physician Office
Lab Director DR. ANDRE KRAINIK

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