52D2179417 CLIA NUMBER - PROCARE MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 52D2179417
  • Facility Name: PROCARE MEDICAL GROUP
  • Facility Address: 613 N 36TH ST
    MILWAUKEE, WI
    ZIP 53208
  • Facility Phone: 414 291-2626
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. SHAKAIB MOHAMMAD RAZZAQ
  • NPI Number: 1922164656
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 52D2179417
LAB Type Physician Office
Facility Name PROCARE MEDICAL GROUP
Street 613 N 36TH ST
City MILWAUKEE
State WI
ZIP 53208
Phone 414 291-2626
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 2/24/2024
Certificate Expiration Date 2/23/2026
Facility Type Physician Office
Lab Director DR. SHAKAIB MOHAMMAD RAZZAQ

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