14D0982801 CLIA NUMBER - ILLINOIS INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 14D0982801
  • Facility Name: ILLINOIS INTERNAL MEDICINE
  • Facility Address: 890 GARFIELD AVENUE, #209
    LIBERTYVILLE, IL
    ZIP 60048
  • Facility Phone: 847 367-3060
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARK J. CHYNA MD
  • NPI Number: 1659597730
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D0982801
LAB Type Physician Office
Facility Name ILLINOIS INTERNAL MEDICINE
Street 890 GARFIELD AVENUE, #209
City LIBERTYVILLE
State IL
ZIP 60048
Phone 847 367-3060
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/5/2025
Certificate Expiration Date 2/4/2027
Facility Type Physician Office
Lab Director MARK J. CHYNA MD

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