52D2012019 CLIA NUMBER - BLUEMOUND DIALYSIS

Laboratory Demographics

  • CLIA Code: 52D2012019
  • Facility Name: BLUEMOUND DIALYSIS
  • Facility Address: 601 N 99TH ST, STE 100
    WAUWATOSA, WI
    ZIP 53226
  • Facility Phone: 414 788-1623
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. MANOHAR AHUJA
  • NPI Number: 1528386836
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 52D2012019
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name BLUEMOUND DIALYSIS
Street 601 N 99TH ST, STE 100
City WAUWATOSA
State WI
ZIP 53226
Phone 414 788-1623
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/26/2024
Certificate Expiration Date 8/25/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. MANOHAR AHUJA

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