14D0916413 CLIA NUMBER - NOWOBILSKA MEDICAL PRACTICE LTD

Laboratory Demographics

CLIA Number: 14D0916413

Facility Name: NOWOBILSKA MEDICAL PRACTICE LTD

Facility Address:
5257 S CICERO AVE
CHICAGO, IL
ZIP 60632
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Facility Phone Number: 773 735-8038

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1013217785

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0916413
LAB Type	Physician Office
Facility Name	NOWOBILSKA MEDICAL PRACTICE LTD
Street	5257 S CICERO AVE
City	CHICAGO
State	IL
ZIP	60632
Phone	773 735-8038
CertificateType	4
CertificateEffectiveDate	6/21/2022
CertificateExpirationDate	6/20/2024
FacilityType	Waiver

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