14D0422734 CLIA NUMBER - LAKESIDE NEPHROLOGY LTD

Laboratory Demographics

  • CLIA Code: 14D0422734
  • Facility Name: LAKESIDE NEPHROLOGY LTD
  • Facility Address: 1101 SOUTH CANAL STREET
    CHICAGO, IL
    ZIP 60607
  • Facility Phone: (312) 986-0110
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: W BRIAN DUFFY MD
  • NPI Number: 1942951488
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 14D0422734
LAB Type Physician Office
Facility Name LAKESIDE NEPHROLOGY LTD
Street 1101 SOUTH CANAL STREET
City CHICAGO
State IL
ZIP 60607
Phone 3129860110
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 3/5/2026
Certificate Expiration Date 3/4/2028
Facility Type Physician Office
Lab Director W BRIAN DUFFY MD

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