14D0412607 CLIA NUMBER - LAKE COUNTY PEDIATRICS SC

Laboratory Demographics

  • CLIA Code: 14D0412607
  • Facility Name: LAKE COUNTY PEDIATRICS SC
  • Facility Address: 1 S GREENLEAF ST, STE E
    GURNEE, IL
    ZIP 60031
  • Facility Phone: 847 336-0770
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARLENE TANQUILUT MD
  • NPI Number: 1114102530
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 14D0412607
LAB Type Physician Office
Facility Name LAKE COUNTY PEDIATRICS SC
Street 1 S GREENLEAF ST, STE E
City GURNEE
State IL
ZIP 60031
Phone 847 336-0770
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/26/2025
Certificate Expiration Date 7/25/2027
Facility Type Physician Office
Lab Director MARLENE TANQUILUT MD

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