14D0896534 CLIA NUMBER - CHILDREN & TEENS MEDICAL CENTER

Laboratory Demographics

CLIA Number: 14D0896534

Facility Name: CHILDREN & TEENS MEDICAL CENTER

Facility Address:
620 SOUTH MAIN STREET
ALGONQUIN, IL
ZIP 60102
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Facility Phone Number: 847 854-5900

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1154597029

Taxonomy: 2084N0402X - Psychiatry & Neurology
A Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence.

CLIA Record

Field Name	Field Value
CLIA Number	14D0896534
LAB Type	Physician Office
Facility Name	CHILDREN & TEENS MEDICAL CENTER
Street	620 SOUTH MAIN STREET
City	ALGONQUIN
State	IL
ZIP	60102
Phone	847 854-5900
CertificateType	4
CertificateEffectiveDate	8/20/2023
CertificateExpirationDate	8/19/2025
FacilityType	Waiver

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