14D0993499 CLIA NUMBER - LAKE FOREST INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 14D0993499
  • Facility Name: LAKE FOREST INTERNAL MEDICINE
  • Facility Address: 1800 HOLLISTER DRIVE SUITE 211
    LIBERTYVILLE, IL
    ZIP 60048
  • Facility Phone: 847 816-3084
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MARK W. RIEDERMAN MD
  • NPI Number: 1871786731
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D0993499
LAB Type Physician Office
Facility Name LAKE FOREST INTERNAL MEDICINE
Street 1800 HOLLISTER DRIVE SUITE 211
City LIBERTYVILLE
State IL
ZIP 60048
Phone 847 816-3084
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 11/15/2023
Certificate Expiration Date 11/14/2025
Facility Type Physician Office
Lab Director MARK W. RIEDERMAN MD

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