14D1009788 CLIA NUMBER - PRESENCE MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 14D1009788
  • Facility Name: PRESENCE MEDICAL GROUP
  • Facility Address: 711 W NORTH AVE - STE 209
    CHICAGO, IL
    ZIP 60610
  • Facility Phone: 847 493-5336
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROSS A. SLOTTEN MD
  • NPI Number: 1487028825
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D1009788
LAB Type Physician Office
Facility Name PRESENCE MEDICAL GROUP
Street 711 W NORTH AVE - STE 209
City CHICAGO
State IL
ZIP 60610
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 2/25/2025
Certificate Expiration Date 2/24/2027
Facility Type Physician Office
Lab Director ROSS A. SLOTTEN MD

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