14D0888346 CLIA NUMBER - INNOVATIVE PLATINUM CARE

Laboratory Demographics

CLIA Number: 14D0888346

Facility Name: INNOVATIVE PLATINUM CARE

Facility Address:
2363 N CALIFORNIA
CHICAGO, IL
ZIP 60647
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Facility Phone Number: 773 278-7024

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1285754879

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	14D0888346
LAB Type	Physician Office
Facility Name	INNOVATIVE PLATINUM CARE
Street	2363 N CALIFORNIA
City	CHICAGO
State	IL
ZIP	60647
Phone	773 278-7024
CertificateType	4
CertificateEffectiveDate	7/1/2022
CertificateExpirationDate	6/30/2024
FacilityType	Waiver

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