52D2063719 CLIA NUMBER - AGELESS WELLNESS CENTER, INC

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Laboratory Demographics

CLIA Number: 52D2063719

Facility Name: AGELESS WELLNESS CENTER, INC

Facility Address:
2745 WEST LAYTON AVENUE SUITE 203
MILWAUKEE, WI
ZIP 53221
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Facility Phone Number: 414 475-5800

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1245672856

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	52D2063719
LAB Type	Physician Office
Facility Name	AGELESS WELLNESS CENTER, INC
Street	2745 WEST LAYTON AVENUE SUITE 203
City	MILWAUKEE
State	WI
ZIP	53221
Phone	414 475-5800
CertificateType	4
CertificateEffectiveDate	8/7/2023
CertificateExpirationDate	8/6/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024