14D2036399 CLIA NUMBER - DERMATOLOGY & AESTHETICS - STREETERVILLE

Laboratory Demographics

  • CLIA Code: 14D2036399
  • Facility Name: DERMATOLOGY & AESTHETICS - STREETERVILLE
  • Facility Address: 680 N LAKE SHORE DR - STE 930
    CHICAGO, IL
    ZIP 60611
  • Facility Phone: 312 861-3911
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: TORAL D. PATEL
  • NPI Number: 1063978138
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 14D2036399
LAB Type Physician Office
Facility Name DERMATOLOGY & AESTHETICS - STREETERVILLE
Street 680 N LAKE SHORE DR - STE 930
City CHICAGO
State IL
ZIP 60611
Phone 312 861-3911
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 2/7/2024
Certificate Expiration Date 2/6/2026
Facility Type Physician Office
Lab Director TORAL D. PATEL

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