14D0993877 CLIA NUMBER - EZEQUIEL MENDEZ-HUERTA MD

Laboratory Demographics

  • CLIA Code: 14D0993877
  • Facility Name: EZEQUIEL MENDEZ-HUERTA MD
  • Facility Address: 4121 SOUTH ARCHER
    CHICAGO, IL
    ZIP 60632
  • Facility Phone: (773) 254-2525
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EZEQUIEL MENDEZ-HUERTA
  • NPI Number: 1346324555
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D0993877
LAB Type Physician Office
Facility Name EZEQUIEL MENDEZ-HUERTA MD
Street 4121 SOUTH ARCHER
City CHICAGO
State IL
ZIP 60632
Phone 7732542525
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/28/2025
Certificate Expiration Date 11/27/2027
Facility Type Physician Office
Lab Director EZEQUIEL MENDEZ-HUERTA

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This page was last updated on: 5/15/2026