52D2040979 CLIA NUMBER - FOREFRONT DERMATOLOGY, SC

Laboratory Demographics

  • CLIA Code: 52D2040979
  • Facility Name: FOREFRONT DERMATOLOGY, SC
  • Facility Address: 1990 GODFREY DR STE 119
    WAUPACA, WI
    ZIP 54981
  • Facility Phone: 715 258-3041
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. KURT W. GRELCK
  • NPI Number: 1306112230
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 52D2040979
LAB Type Physician Office
Facility Name FOREFRONT DERMATOLOGY, SC
Street 1990 GODFREY DR STE 119
City WAUPACA
State WI
ZIP 54981
Phone 715 258-3041
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 5/15/2024
Certificate Expiration Date 5/14/2026
Facility Type Physician Office
Lab Director DR. KURT W. GRELCK

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