14D0414039 CLIA NUMBER - ROUND LAKE MEDICAL

Laboratory Demographics

  • CLIA Code: 14D0414039
  • Facility Name: ROUND LAKE MEDICAL
  • Facility Address: 2 E ROLLINS RD
    ROUND LAKE, IL
    ZIP 60073
  • Facility Phone: (708) 546-9455
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: IRA F. FENTON
  • NPI Number: 1225563380
  • Taxonomy: 261QM1200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D0414039
LAB Type Physician Office
Facility Name ROUND LAKE MEDICAL
Street 2 E ROLLINS RD
City ROUND LAKE
State IL
ZIP 60073
Phone 7085469455
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director IRA F. FENTON

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This page was last updated on: 5/18/2026