14D1006088 CLIA NUMBER - PEDIATRIC CLINIC LTD/ M STAISL MD

Laboratory Demographics

  • CLIA Code: 14D1006088
  • Facility Name: PEDIATRIC CLINIC LTD/ M STAISL MD
  • Facility Address: 6416 WEST BELMONT
    CHICAGO, IL
    ZIP 60634
  • Facility Phone: 773 725-5400
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARIA STAISZ MD
  • NPI Number: 1568531903
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 14D1006088
LAB Type Physician Office
Facility Name PEDIATRIC CLINIC LTD/ M STAISL MD
Street 6416 WEST BELMONT
City CHICAGO
State IL
ZIP 60634
Phone 773 725-5400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/6/2024
Certificate Expiration Date 11/5/2026
Facility Type Physician Office
Lab Director MARIA STAISZ MD

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