14D0998862 CLIA NUMBER - SRINIVAS C KOTA MD SC

Laboratory Demographics

  • CLIA Code: 14D0998862
  • Facility Name: SRINIVAS C KOTA MD SC
  • Facility Address: 726 S WEBER RD
    BOLINGBROOK, IL
    ZIP 60490
  • Facility Phone: 630 378-9785
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SRINIVAS C. KOTA
  • NPI Number: 1659481562
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D0998862
LAB Type Physician Office
Facility Name SRINIVAS C KOTA MD SC
Street 726 S WEBER RD
City BOLINGBROOK
State IL
ZIP 60490
Phone 630 378-9785
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 SRINIVAS C. KOTA

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