14D0996578 CLIA NUMBER - PRESENCE MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 14D0996578
  • Facility Name: PRESENCE MEDICAL GROUP
  • Facility Address: 1625 SHERIDAN RD
    WILMETTE, IL
    ZIP 60091
  • Facility Phone: 847 493-5336
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JONATHAN H. MAKS
  • NPI Number: 1336580026
  • Taxonomy: 261QR0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D0996578
LAB Type Physician Office
Facility Name PRESENCE MEDICAL GROUP
Street 1625 SHERIDAN RD
City WILMETTE
State IL
ZIP 60091
Phone 847 493-5336
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/7/2024
Certificate Expiration Date 1/6/2026
Facility Type Physician Office
Lab Director JONATHAN H. MAKS

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