14D1056029 CLIA NUMBER - PREMIER DERMATOLOGY FOREFRONT DERMATOLOGY S C

Laboratory Demographics

  • CLIA Code: 14D1056029
  • Facility Name: PREMIER DERMATOLOGY FOREFRONT DERMATOLOGY S C
  • Facility Address: 1600 W ROUTE 6
    MORRIS, IL
    ZIP 60450
  • Facility Phone: 815 941-9500
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: CRISTINA R. CAMARA
  • NPI Number: 1548632805
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 14D1056029
LAB Type Physician Office
Facility Name PREMIER DERMATOLOGY FOREFRONT DERMATOLOGY S C
Street 1600 W ROUTE 6
City MORRIS
State IL
ZIP 60450
Phone 815 941-9500
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/23/2024
Certificate Expiration Date 10/22/2026
Facility Type Physician Office
Lab Director CRISTINA R. CAMARA

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