14D0432129 CLIA NUMBER - CENTRAL ILLINOIS DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 14D0432129
  • Facility Name: CENTRAL ILLINOIS DERMATOLOGY
  • Facility Address: 5401 N KNOXVILLE SUITE 115
    PEORIA, IL
    ZIP 61614
  • Facility Phone: 309 691-2903
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: CHRISTOPHER T. KROODSMA M D
  • NPI Number: 1548358054
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 14D0432129
LAB Type Physician Office
Facility Name CENTRAL ILLINOIS DERMATOLOGY
Street 5401 N KNOXVILLE SUITE 115
City PEORIA
State IL
ZIP 61614
Phone 309 691-2903
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 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director CHRISTOPHER T. KROODSMA M D

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