14D0694244 CLIA NUMBER - MICHIGAN AVENUE INTERNISTS LLC

Laboratory Demographics

  • CLIA Code: 14D0694244
  • Facility Name: MICHIGAN AVENUE INTERNISTS LLC
  • Facility Address: 200 SOUTH MICHIGAN SUITE #805
    CHICAGO, IL
    ZIP 60604
  • Facility Phone: 312 922-1287
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SHIRLEY TER MOLEN MD
  • NPI Number: 1063568210
  • Taxonomy: 103G00000X - Clinical Neuropsychologist

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CLIA Record

Field Name Field Value
CLIA Number 14D0694244
LAB Type Physician Office
Facility Name MICHIGAN AVENUE INTERNISTS LLC
Street 200 SOUTH MICHIGAN SUITE #805
City CHICAGO
State IL
ZIP 60604
Phone 312 922-1287
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/22/2024
Certificate Expiration Date 3/21/2026
Facility Type Physician Office
Lab Director SHIRLEY TER MOLEN MD

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