14D2060831 CLIA NUMBER - BEVERLY PARK MEDICAL CENTER

Laboratory Demographics

  • CLIA Code: 14D2060831
  • Facility Name: BEVERLY PARK MEDICAL CENTER
  • Facility Address: 11012 S WESTERN AVE
    CHICAGO, IL
    ZIP 60643
  • Facility Phone: 773 298-0990
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL FOREMAN
  • NPI Number: 1669695730
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D2060831
LAB Type Physician Office
Facility Name BEVERLY PARK MEDICAL CENTER
Street 11012 S WESTERN AVE
City CHICAGO
State IL
ZIP 60643
Phone 773 298-0990
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/19/2025
Certificate Expiration Date 6/18/2027
Facility Type Physician Office
Lab Director MICHAEL FOREMAN

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