14D0677638 CLIA NUMBER - LAKE SHORE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 14D0677638
  • Facility Name: LAKE SHORE PEDIATRICS
  • Facility Address: 1800 HOLLISTER DRIVE SUITE 220
    LIBERTYVILLE, IL
    ZIP 60048
  • Facility Phone: 847 362-5707
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SHERI K. ROSS
  • NPI Number: 1629363064
  • Taxonomy: 261QP2000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D0677638
LAB Type Physician Office
Facility Name LAKE SHORE PEDIATRICS
Street 1800 HOLLISTER DRIVE SUITE 220
City LIBERTYVILLE
State IL
ZIP 60048
Phone 847 362-5707
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/12/2025
Certificate Expiration Date 6/11/2027
Facility Type Physician Office
Lab Director SHERI K. ROSS

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