14D1015491 CLIA NUMBER - PROFESSIONAL FOOT CARE SPECIALISTS

Laboratory Demographics

CLIA Number: 14D1015491

Facility Name: PROFESSIONAL FOOT CARE SPECIALISTS

Facility Address:
5241 S CICERO AVE, STE 103
CHICAGO, IL
ZIP 60632
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Facility Phone Number: 773 284-8811

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1063615557

Taxonomy: 213EP1101X - Podiatrist

CLIA Record

Field Name	Field Value
CLIA Number	14D1015491
LAB Type	Physician Office
Facility Name	PROFESSIONAL FOOT CARE SPECIALISTS
Street	5241 S CICERO AVE, STE 103
City	CHICAGO
State	IL
ZIP	60632
Phone	773 284-8811
CertificateType	4
CertificateEffectiveDate	4/11/2023
CertificateExpirationDate	4/10/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024