14D0998861 CLIA NUMBER - FULLERTON SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 14D0998861
  • Facility Name: FULLERTON SURGERY CENTER
  • Facility Address: 4849 W FULLERTON AVE
    CHICAGO, IL
    ZIP 60639
  • Facility Phone: 773 237-0755
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NASER RUSTOM MD
  • NPI Number: 1376780205
  • Taxonomy: 225100000X - Physical Therapist

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 14D0998861
LAB Type Physician Office
Facility Name FULLERTON SURGERY CENTER
Street 4849 W FULLERTON AVE
City CHICAGO
State IL
ZIP 60639
Phone 773 237-0755
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/26/2024
Certificate Expiration Date 4/25/2026
Facility Type Physician Office
Lab Director NASER RUSTOM MD

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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