14D0414787 CLIA NUMBER - 530 WINNETKA LAB

Laboratory Demographics

  • CLIA Code: 14D0414787
  • Facility Name: 530 WINNETKA LAB
  • Facility Address: 530 WINNETKA AVE
    WINNETKA, IL
    ZIP 60093
  • Facility Phone: 847 441-6868
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NAN L. MARTIN
  • NPI Number: 1760695381
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D0414787
LAB Type Physician Office
Facility Name 530 WINNETKA LAB
Street 530 WINNETKA AVE
City WINNETKA
State IL
ZIP 60093
Phone 847 441-6868
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/3/2024
Certificate Expiration Date 4/2/2026
Facility Type Physician Office
Lab Director NAN L. MARTIN

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