14D0911240 CLIA NUMBER - STEPHEN J BUNDRA MD SC

Laboratory Demographics

  • CLIA Code: 14D0911240
  • Facility Name: STEPHEN J BUNDRA MD SC
  • Facility Address: 1921 LAKE AVENUE, SUITE B
    WILMETTE, IL
    ZIP 60091
  • Facility Phone: 847 853-9100
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: STEPHEN J. BUNDRA MD
  • NPI Number: 1326064387
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D0911240
LAB Type Physician Office
Facility Name STEPHEN J BUNDRA MD SC
Street 1921 LAKE AVENUE, SUITE B
City WILMETTE
State IL
ZIP 60091
Phone 847 853-9100
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 6/4/2024
Certificate Expiration Date 6/3/2026
Facility Type Physician Office
Lab Director STEPHEN J. BUNDRA MD

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