14D0724414 CLIA NUMBER - LOGAN SQUARE DIALYSIS

Laboratory Demographics

  • CLIA Code: 14D0724414
  • Facility Name: LOGAN SQUARE DIALYSIS
  • Facility Address: 2838 N KIMBALL AVE
    CHICAGO, IL
    ZIP 60618
  • Facility Phone: 773 276-3699
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: KAP J. NO MD
  • NPI Number: 1841389830
  • Taxonomy: 261QP1100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D0724414
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name LOGAN SQUARE DIALYSIS
Street 2838 N KIMBALL AVE
City CHICAGO
State IL
ZIP 60618
Phone 773 276-3699
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 End Stage Renal Disease Dialysis Facility
Lab Director KAP J. NO MD

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