52D2006919 CLIA NUMBER - MEDICAL DIAGNOSTIC IMAGING

Laboratory Demographics

  • CLIA Code: 52D2006919
  • Facility Name: MEDICAL DIAGNOSTIC IMAGING
  • Facility Address: 3077 N MAYFAIR ROAD SUITE 115
    WAUWATOSA, WI
    ZIP 53222
  • Facility Phone: 414 847-1800
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: MS. CONNIE SLOMCZEWSKI
  • NPI Number: 1427165331
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 52D2006919
LAB Type Practitioner Other
Facility Name MEDICAL DIAGNOSTIC IMAGING
Street 3077 N MAYFAIR ROAD SUITE 115
City WAUWATOSA
State WI
ZIP 53222
Phone 414 847-1800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/4/2024
Certificate Expiration Date 5/3/2026
Facility Type Practitioner Other
Lab Director MS. CONNIE SLOMCZEWSKI

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