52D2029954 CLIA NUMBER - FOREFRONT DERMATOLOGY, SC

Laboratory Demographics

  • CLIA Code: 52D2029954
  • Facility Name: FOREFRONT DERMATOLOGY, SC
  • Facility Address: W7713 JOHNSON CT
    WAUTOMA, WI
    ZIP 54982
  • Facility Phone: 920 895-1004
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. KURT W. GRELCK
  • NPI Number: 1922605880
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 52D2029954
LAB Type Physician Office
Facility Name FOREFRONT DERMATOLOGY, SC
Street W7713 JOHNSON CT
City WAUTOMA
State WI
ZIP 54982
Phone 920 895-1004
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/27/2023
Certificate Expiration Date 11/26/2025
Facility Type Physician Office
Lab Director DR. KURT W. GRELCK

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