52D2112431 CLIA NUMBER - LAKE DELTON DIALYSIS

Laboratory Demographics

  • CLIA Code: 52D2112431
  • Facility Name: LAKE DELTON DIALYSIS
  • Facility Address: 14 CTY RD P
    WISCONSIN DELLS, WI
    ZIP 53965
  • Facility Phone: 608 253-3597
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. ALI I. GARDEZI
  • NPI Number: 1639535263
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 52D2112431
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name LAKE DELTON DIALYSIS
Street 14 CTY RD P
City WISCONSIN DELLS
State WI
ZIP 53965
Phone 608 253-3597
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/28/2024
Certificate Expiration Date 4/27/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. ALI I. GARDEZI

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This page was last updated on: 6/4/2025