14D0424497 CLIA NUMBER - LAKE SHORE MEDICAL ASSOCIATES LTD

Laboratory Demographics

CLIA Number: 14D0424497

Facility Name: LAKE SHORE MEDICAL ASSOCIATES LTD

Facility Address:
2734 N LINCOLN AVENUE
CHICAGO, IL
ZIP 60614
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Facility Phone Number: 773 525-7720

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1093703688

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	14D0424497
LAB Type	Physician Office
Facility Name	LAKE SHORE MEDICAL ASSOCIATES LTD
Street	2734 N LINCOLN AVENUE
City	CHICAGO
State	IL
ZIP	60614
Phone	773 525-7720
CertificateType	3
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	PPMP

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