52D0868858 CLIA NUMBER - OCONOMOWOC DIALYSIS

Laboratory Demographics

  • CLIA Code: 52D0868858
  • Facility Name: OCONOMOWOC DIALYSIS
  • Facility Address: 1253 CORPORATE CENTER DR
    OCONOMOWOC, WI
    ZIP 53066
  • Facility Phone: 262 567-3199
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. LOGANATHAN ELANGOVAN
  • NPI Number: 1871679480
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 52D0868858
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name OCONOMOWOC DIALYSIS
Street 1253 CORPORATE CENTER DR
City OCONOMOWOC
State WI
ZIP 53066
Phone 262 567-3199
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. LOGANATHAN ELANGOVAN

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