14D0944993 CLIA NUMBER - PROVIDEA HEALTH PARTNERS LLC

Laboratory Demographics

CLIA Number: 14D0944993

Facility Name: PROVIDEA HEALTH PARTNERS LLC

Facility Address:
9730 S WESTERN AVE - STE 700
EVERGREEN PARK, IL
ZIP 60805
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Facility Phone Number: 708 425-1907

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1770911208

Taxonomy: 207V00000X - Obstetrics & Gynecology
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.

CLIA Record

Field Name	Field Value
CLIA Number	14D0944993
LAB Type	Physician Office
Facility Name	PROVIDEA HEALTH PARTNERS LLC
Street	9730 S WESTERN AVE - STE 700
City	EVERGREEN PARK
State	IL
ZIP	60805
Phone	708 425-1907
CertificateType	3
CertificateEffectiveDate	3/18/2023
CertificateExpirationDate	3/17/2025
FacilityType	PPMP

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