14D0949450 CLIA NUMBER - PHOENIX MED ASSOC

Laboratory Demographics

  • CLIA Code: 14D0949450
  • Facility Name: PHOENIX MED ASSOC
  • Facility Address: 3718 NORTH ASHLAND, SUITE 1
    CHICAGO, IL
    ZIP 60613
  • Facility Phone: 773 327-9900
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: FLORIAN MIRANZADEH
  • NPI Number: 1043542525
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D0949450
LAB Type Physician Office
Facility Name PHOENIX MED ASSOC
Street 3718 NORTH ASHLAND, SUITE 1
City CHICAGO
State IL
ZIP 60613
Phone 773 327-9900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/25/2025
Certificate Expiration Date 4/24/2027
Facility Type Physician Office
Lab Director FLORIAN MIRANZADEH

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