14D1037224 CLIA NUMBER - LAKE VILLA DIALYSIS

Laboratory Demographics

  • CLIA Code: 14D1037224
  • Facility Name: LAKE VILLA DIALYSIS
  • Facility Address: 37809 N ROUTE 59
    LAKE VILLA, IL
    ZIP 60046
  • Facility Phone: 773 276-2380
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: OMAR DALLOUL
  • NPI Number: 1861457558
  • Taxonomy: 207R00000X - Internal Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 14D1037224
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name LAKE VILLA DIALYSIS
Street 37809 N ROUTE 59
City LAKE VILLA
State IL
ZIP 60046
Phone 773 276-2380
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/17/2025
Certificate Expiration Date 2/16/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director OMAR DALLOUL

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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