52D0984831 CLIA NUMBER - LAKESHORE MEDICAL CLINIC, LLC D/B/A AURORA HEALTH CENTER CUDAHY- LAKE DRIVE (LABORATORY)

Laboratory Demographics

  • CLIA Code: 52D0984831
  • Facility Name: LAKESHORE MEDICAL CLINIC, LLC D/B/A AURORA HEALTH CENTER CUDAHY- LAKE DRIVE (LABORATORY)
  • Facility Address: 5900 S LAKE DR
    CUDAHY, WI
    ZIP 53110
  • Facility Phone: 414 489-4525
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. KIERAN SULTAN-LUNDEEN
  • NPI Number: 1265597645
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 52D0984831
LAB Type Physician Office
Facility Name LAKESHORE MEDICAL CLINIC, LLC D/B/A AURORA HEALTH CENTER CUDAHY- LAKE DRIVE (LABORATORY)
Street 5900 S LAKE DR
City CUDAHY
State WI
ZIP 53110
Phone 414 489-4525
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/13/2024
Certificate Expiration Date 1/12/2026
Facility Type Physician Office
Lab Director DR. KIERAN SULTAN-LUNDEEN

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This page was last updated on: 6/4/2025