14D1094715 CLIA NUMBER - CENTER FOR INTERNAL MEDICINE

Laboratory Demographics

CLIA Number: 14D1094715

Facility Name: CENTER FOR INTERNAL MEDICINE

Facility Address:
4609 W 103RD STREET
OAK LAWN, IL
ZIP 60453
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Facility Phone Number: 708 425-0070

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1093952756

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1094715
LAB Type	Physician Office
Facility Name	CENTER FOR INTERNAL MEDICINE
Street	4609 W 103RD STREET
City	OAK LAWN
State	IL
ZIP	60453
Phone	708 425-0070
CertificateType	4
CertificateEffectiveDate	1/26/2023
CertificateExpirationDate	1/25/2025
FacilityType	Waiver

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