14D0984060 CLIA NUMBER - METRO INFECTIOUS DISEASE CONSULTANTS P L C

Laboratory Demographics

  • CLIA Code: 14D0984060
  • Facility Name: METRO INFECTIOUS DISEASE CONSULTANTS P L C
  • Facility Address: 13755 S CICERO AVE
    CRESTWOOD, IL
    ZIP 60445
  • Facility Phone: 630 654-4201
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RUSSELL M. PETRAK M D
  • NPI Number: 1811324064
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D0984060
LAB Type Physician Office
Facility Name METRO INFECTIOUS DISEASE CONSULTANTS P L C
Street 13755 S CICERO AVE
City CRESTWOOD
State IL
ZIP 60445
Phone 630 654-4201
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/3/2024
Certificate Expiration Date 4/2/2026
Facility Type Physician Office
Lab Director RUSSELL M. PETRAK M D

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