14D2000307 CLIA NUMBER - PEACE MEDICAL GROUP INC

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Laboratory Demographics

CLIA Number: 14D2000307

Facility Name: PEACE MEDICAL GROUP INC

Facility Address:
234 W CERMAK RD, 1ST FL
CHICAGO, IL
ZIP 60616
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Facility Phone Number: 312 808-0880

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1619204625

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2000307
LAB Type	Physician Office
Facility Name	PEACE MEDICAL GROUP INC
Street	234 W CERMAK RD, 1ST FL
City	CHICAGO
State	IL
ZIP	60616
Phone	312 808-0880
CertificateType	4
CertificateEffectiveDate	8/20/2022
CertificateExpirationDate	8/19/2024
FacilityType	Waiver

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