52D2318294 CLIA NUMBER - MEDCO MILWAUKEE LLC

Laboratory Demographics

  • CLIA Code: 52D2318294
  • Facility Name: MEDCO MILWAUKEE LLC
  • Facility Address: 1340 W TOWNE SQUARE RD STE 5
    MEQUON, WI
    ZIP 53092
  • Facility Phone: 262 292-8101
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DMITRIY CHESTER
  • NPI Number: 1306542394
  • Taxonomy: 363L00000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 52D2318294
LAB Type Physician Office
Facility Name MEDCO MILWAUKEE LLC
Street 1340 W TOWNE SQUARE RD STE 5
City MEQUON
State WI
ZIP 53092
Phone 262 292-8101
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/7/2025
Certificate Expiration Date 2/6/2027
Facility Type Physician Office
Lab Director DMITRIY CHESTER

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