14D0950306 CLIA NUMBER - LAKESIDE NEPHROLOGY LTD

Laboratory Demographics

  • CLIA Code: 14D0950306
  • Facility Name: LAKESIDE NEPHROLOGY LTD
  • Facility Address: 1717 SOUTH WABASH STREET
    CHICAGO, IL
    ZIP 60616
  • Facility Phone: (312) 913-0110
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Microscopy
  • Lab Director: SHELDON HIRSCH
  • NPI Number: 1649433376
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 14D0950306
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name LAKESIDE NEPHROLOGY LTD
Street 1717 SOUTH WABASH STREET
City CHICAGO
State IL
ZIP 60616
Phone 3129130110
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 8/21/2024
Certificate Expiration Date 8/20/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director SHELDON HIRSCH

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This page was last updated on: 5/18/2026