52D1089424 CLIA NUMBER - MEQUON ROAD DIALYSIS

Laboratory Demographics

  • CLIA Code: 52D1089424
  • Facility Name: MEQUON ROAD DIALYSIS
  • Facility Address: W175N11056 STONEWOOD
    GERMANTOWN, WI
    ZIP 53022
  • Facility Phone: 262 251-3044
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. LISA HALLER
  • NPI Number: 1912448374
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 52D1089424
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name MEQUON ROAD DIALYSIS
Street W175N11056 STONEWOOD
City GERMANTOWN
State WI
ZIP 53022
Phone 262 251-3044
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/17/2024
Certificate Expiration Date 9/16/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. LISA HALLER

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