14D1018794 CLIA NUMBER - MAPLE AVENUE KIDNEY CENTER

Laboratory Demographics

  • CLIA Code: 14D1018794
  • Facility Name: MAPLE AVENUE KIDNEY CENTER
  • Facility Address: 610 S MAPLE AVE-SUITE 4100
    OAK PARK, IL
    ZIP 60304
  • Facility Phone: 708 660-4100
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: HAMID HUMAYUN
  • NPI Number: 1891707196
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D1018794
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name MAPLE AVENUE KIDNEY CENTER
Street 610 S MAPLE AVE-SUITE 4100
City OAK PARK
State IL
ZIP 60304
Phone 708 660-4100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/8/2024
Certificate Expiration Date 1/7/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director HAMID HUMAYUN

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