14D0421608 CLIA NUMBER - LA GRANGE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 14D0421608
  • Facility Name: LA GRANGE PEDIATRICS
  • Facility Address: 4727 WILLOW SPRINGS RD
    LA GRANGE, IL
    ZIP 60525
  • Facility Phone: 708 588-0088
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JULIE C. TUMMA
  • NPI Number: 1033299649
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 14D0421608
LAB Type Physician Office
Facility Name LA GRANGE PEDIATRICS
Street 4727 WILLOW SPRINGS RD
City LA GRANGE
State IL
ZIP 60525
Phone 708 588-0088
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/23/2025
Certificate Expiration Date 7/22/2027
Facility Type Physician Office
Lab Director JULIE C. TUMMA

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