14D0427012 CLIA NUMBER - JOHN A WILEY MD

Laboratory Demographics

  • CLIA Code: 14D0427012
  • Facility Name: JOHN A WILEY MD
  • Facility Address: 5300 W DIVERSEY AVE
    CHICAGO, IL
    ZIP 60639
  • Facility Phone: 312 725-0990
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOHN A. WILEY
  • NPI Number: 1487612834
  • Taxonomy: 207RG0300X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D0427012
LAB Type Physician Office
Facility Name JOHN A WILEY MD
Street 5300 W DIVERSEY AVE
City CHICAGO
State IL
ZIP 60639
Phone 312 725-0990
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director JOHN A. WILEY

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