14D1065376 CLIA NUMBER - WINNETKA AVENUE PHYSICIANS S C

Laboratory Demographics

  • CLIA Code: 14D1065376
  • Facility Name: WINNETKA AVENUE PHYSICIANS S C
  • Facility Address: 525 WINNETKA AVE
    WINNETKA, IL
    ZIP 60093
  • Facility Phone: 847 501-4060
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROMAN MANDZIJ
  • NPI Number: 1346633971
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D1065376
LAB Type Physician Office
Facility Name WINNETKA AVENUE PHYSICIANS S C
Street 525 WINNETKA AVE
City WINNETKA
State IL
ZIP 60093
Phone 847 501-4060
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/28/2025
Certificate Expiration Date 2/27/2027
Facility Type Physician Office
Lab Director ROMAN MANDZIJ

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