14D0416931 CLIA NUMBER - HEATHER CUSHING GYNECOLOGY

Laboratory Demographics

CLIA Number: 14D0416931

Facility Name: HEATHER CUSHING GYNECOLOGY

Facility Address:
800 ROOSEVELT RD - STE B-114
GLEN ELLYN, IL
ZIP 60137
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Facility Phone Number: 630 474-2626

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1023093572

Taxonomy: 207V00000X - Obstetrics & Gynecology
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.

CLIA Record

Field Name	Field Value
CLIA Number	14D0416931
LAB Type	Physician Office
Facility Name	HEATHER CUSHING GYNECOLOGY
Street	800 ROOSEVELT RD - STE B-114
City	GLEN ELLYN
State	IL
ZIP	60137
Phone	630 474-2626
CertificateType	4
CertificateEffectiveDate	1/14/2024
CertificateExpirationDate	1/13/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024