52D1004154 CLIA NUMBER - GREEN BAY DIALYSIS

Laboratory Demographics

  • CLIA Code: 52D1004154
  • Facility Name: GREEN BAY DIALYSIS
  • Facility Address: 1751 DECKNER AVE
    GREEN BAY, WI
    ZIP 54302
  • Facility Phone: 920 465-0430
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. QAMARUDDIN U. QAZI
  • NPI Number: 1144590084
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 52D1004154
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name GREEN BAY DIALYSIS
Street 1751 DECKNER AVE
City GREEN BAY
State WI
ZIP 54302
Phone 920 465-0430
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/20/2024
Certificate Expiration Date 9/19/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. QAMARUDDIN U. QAZI

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