52D1034716 CLIA NUMBER - FOREFRONT DERMATOLOGY, SC

Laboratory Demographics

  • CLIA Code: 52D1034716
  • Facility Name: FOREFRONT DERMATOLOGY, SC
  • Facility Address: 33 GREEN BAY RD
    STURGEON BAY, WI
    ZIP 54235
  • Facility Phone: 920 746-4434
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. DIANE THALER
  • NPI Number: 1700830650
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 52D1034716
LAB Type Physician Office
Facility Name FOREFRONT DERMATOLOGY, SC
Street 33 GREEN BAY RD
City STURGEON BAY
State WI
ZIP 54235
Phone 920 746-4434
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2025
Certificate Expiration Date 9/30/2027
Facility Type Physician Office
Lab Director DR. DIANE THALER

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