14D0888090 CLIA NUMBER - FRESENIUS MEDICAL CARE MARQUETTE PARK

Laboratory Demographics

CLIA Number: 14D0888090

Facility Name: FRESENIUS MEDICAL CARE MARQUETTE PARK

Facility Address:
6535 S WESTERN AVE
CHICAGO, IL
ZIP 60636
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Facility Phone Number: 773 778-7609

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1740613017

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0888090
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FRESENIUS MEDICAL CARE MARQUETTE PARK
Street	6535 S WESTERN AVE
City	CHICAGO
State	IL
ZIP	60636
Phone	773 778-7609
CertificateType	4
CertificateEffectiveDate	6/22/2022
CertificateExpirationDate	6/21/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024