14D1060046 CLIA NUMBER - EDWARD MEDICAL GROUP 20

Laboratory Demographics

  • CLIA Code: 14D1060046
  • Facility Name: EDWARD MEDICAL GROUP 20
  • Facility Address: 24600 W 127TH ST - BLDG B - STE 100
    PLAINFIELD, IL
    ZIP 60585
  • Facility Phone: 331 221-5376
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MOHAMMED FAYEZA
  • NPI Number: 1184705238
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D1060046
LAB Type Physician Office
Facility Name EDWARD MEDICAL GROUP 20
Street 24600 W 127TH ST - BLDG B - STE 100
City PLAINFIELD
State IL
ZIP 60585
Phone 331 221-5376
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/13/2024
Certificate Expiration Date 10/12/2026
Facility Type Physician Office
Lab Director MOHAMMED FAYEZA

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