14D0886030 CLIA NUMBER - PARK WEST FAMILY PRACTICE ASSOCIATE

Laboratory Demographics

  • CLIA Code: 14D0886030
  • Facility Name: PARK WEST FAMILY PRACTICE ASSOCIATE
  • Facility Address: 2623 N HALSTED
    CHICAGO, IL
    ZIP 60614
  • Facility Phone: 773 929-7410
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SHEFALI SHAH MD
  • NPI Number: 1114931557
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D0886030
LAB Type Physician Office
Facility Name PARK WEST FAMILY PRACTICE ASSOCIATE
Street 2623 N HALSTED
City CHICAGO
State IL
ZIP 60614
Phone 773 929-7410
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/11/2024
Certificate Expiration Date 5/10/2026
Facility Type Physician Office
Lab Director SHEFALI SHAH MD

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