14D1055772 CLIA NUMBER - ALEKSANDR PODOLSKY

Laboratory Demographics

  • CLIA Code: 14D1055772
  • Facility Name: ALEKSANDR PODOLSKY
  • Facility Address: 755 S MILWAUKEE AVE SUITE 164
    LIBERTYVILLE, IL
    ZIP 60048
  • Facility Phone: 847 918-0430
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ALEKSANDR PODOLSKY
  • NPI Number: 1619922135
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D1055772
LAB Type Physician Office
Facility Name ALEKSANDR PODOLSKY
Street 755 S MILWAUKEE AVE SUITE 164
City LIBERTYVILLE
State IL
ZIP 60048
Phone 847 918-0430
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/26/2024
Certificate Expiration Date 6/25/2026
Facility Type Physician Office
Lab Director ALEKSANDR PODOLSKY

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