52D1012900 CLIA NUMBER - STURGEON BAY DIALYSIS

Laboratory Demographics

  • CLIA Code: 52D1012900
  • Facility Name: STURGEON BAY DIALYSIS
  • Facility Address: 108 S 10TH AVE
    STURGEON BAY, WI
    ZIP 54235
  • Facility Phone: 920 746-7955
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: SYED A. SHAH
  • NPI Number: 1104196047
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 52D1012900
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name STURGEON BAY DIALYSIS
Street 108 S 10TH AVE
City STURGEON BAY
State WI
ZIP 54235
Phone 920 746-7955
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/23/2025
Certificate Expiration Date 5/22/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director SYED A. SHAH

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