52D2300413 CLIA NUMBER - COLAB PHYSICIANS, SC

Laboratory Demographics

  • CLIA Code: 52D2300413
  • Facility Name: COLAB PHYSICIANS, SC
  • Facility Address: 10325 N PORT WASHINGTON RD, SUITE 150
    MEQUON, WI
    ZIP 53092
  • Facility Phone: 262 643-4720
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. MARK NIEDFELDT
  • NPI Number: 1902666035
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 52D2300413
LAB Type Physician Office
Facility Name COLAB PHYSICIANS, SC
Street 10325 N PORT WASHINGTON RD, SUITE 150
City MEQUON
State WI
ZIP 53092
Phone 262 643-4720
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/11/2024
Certificate Expiration Date 3/10/2026
Facility Type Physician Office
Lab Director DR. MARK NIEDFELDT

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This page was last updated on: 3/20/2025