14D1093857 CLIA NUMBER - MIDWEST ENDOCRINOLOGY LLC

Laboratory Demographics

CLIA Number: 14D1093857

Facility Name: MIDWEST ENDOCRINOLOGY LLC

Facility Address:
380 N TERRA COTTA RD, SUITE A
CRYSTAL LAKE, IL
ZIP 60012
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Facility Phone Number: 815 444-6362

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1316192685

Taxonomy: 207RE0101X - Internal Medicine
An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems.

CLIA Record

Field Name	Field Value
CLIA Number	14D1093857
LAB Type	Physician Office
Facility Name	MIDWEST ENDOCRINOLOGY LLC
Street	380 N TERRA COTTA RD, SUITE A
City	CRYSTAL LAKE
State	IL
ZIP	60012
Phone	815 444-6362
CertificateType	4
CertificateEffectiveDate	1/5/2023
CertificateExpirationDate	1/4/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024