14D0665475 CLIA NUMBER - NORTHSHORE MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 14D0665475
  • Facility Name: NORTHSHORE MEDICAL GROUP
  • Facility Address: 1000 CENTRAL ST, STE 640
    EVANSTON, IL
    ZIP 60201
  • Facility Phone: 847 570-1410
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KIM GRAHL M D
  • NPI Number: 1528107794
  • Taxonomy: 261QX0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D0665475
LAB Type Physician Office
Facility Name NORTHSHORE MEDICAL GROUP
Street 1000 CENTRAL ST, STE 640
City EVANSTON
State IL
ZIP 60201
Phone 847 570-1410
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/25/2024
Certificate Expiration Date 12/24/2026
Facility Type Physician Office
Lab Director KIM GRAHL M D

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