14D0878451 CLIA NUMBER - BORIS KUSNETZOW MD

Laboratory Demographics

  • CLIA Code: 14D0878451
  • Facility Name: BORIS KUSNETZOW MD
  • Facility Address: 6642 S ASHLAND
    CHICAGO, IL
    ZIP 60636
  • Facility Phone: 773 776-3500
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BORIS KUSNETZOW, MD
  • NPI Number: 1285702357
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D0878451
LAB Type Physician Office
Facility Name BORIS KUSNETZOW MD
Street 6642 S ASHLAND
City CHICAGO
State IL
ZIP 60636
Phone 773 776-3500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/26/2023
Certificate Expiration Date 10/25/2025
Facility Type Physician Office
Lab Director BORIS KUSNETZOW, MD

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