14D0989402 CLIA NUMBER - FAMILY DOCTOR MEDICAL CENTER

Laboratory Demographics

  • CLIA Code: 14D0989402
  • Facility Name: FAMILY DOCTOR MEDICAL CENTER
  • Facility Address: 7201-07 S STONY ISLAND AVE
    CHICAGO, IL
    ZIP 60649
  • Facility Phone: 773 940-1612
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ADEBAYO A. BADEMOSI
  • NPI Number: 1700117942
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D0989402
LAB Type Physician Office
Facility Name FAMILY DOCTOR MEDICAL CENTER
Street 7201-07 S STONY ISLAND AVE
City CHICAGO
State IL
ZIP 60649
Phone 773 940-1612
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/25/2025
Certificate Expiration Date 7/24/2027
Facility Type Physician Office
Lab Director ADEBAYO A. BADEMOSI

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