14D2025451 CLIA NUMBER - FENNER PLASTIC SURGERY

Laboratory Demographics

  • CLIA Code: 14D2025451
  • Facility Name: FENNER PLASTIC SURGERY
  • Facility Address: 512 GREEN BAY RD
    KENILWORTH, IL
    ZIP 60043
  • Facility Phone: 847 716-2400
  • Facility Type: Blood Bank
  • Facility Type: Waiver
  • Lab Director: GEOFFREY FENNER MD
  • NPI Number: 1316194285
  • Taxonomy: 208200000X - Plastic Surgery

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CLIA Record

Field Name Field Value
CLIA Number 14D2025451
LAB Type Blood Bank
Facility Name FENNER PLASTIC SURGERY
Street 512 GREEN BAY RD
City KENILWORTH
State IL
ZIP 60043
Phone 847 716-2400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/9/2025
Certificate Expiration Date 6/8/2027
Facility Type Blood Bank
Lab Director GEOFFREY FENNER MD

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