14D2060833 CLIA NUMBER - JACKSON PARK MEDICAL CENTER

Laboratory Demographics

  • CLIA Code: 14D2060833
  • Facility Name: JACKSON PARK MEDICAL CENTER
  • Facility Address: 7531 S STONY ISLAND - STE 176
    CHICAGO, IL
    ZIP 60649
  • Facility Phone: 773 947-7746
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL T. FOREMAN
  • NPI Number: 1851504161
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D2060833
LAB Type Physician Office
Facility Name JACKSON PARK MEDICAL CENTER
Street 7531 S STONY ISLAND - STE 176
City CHICAGO
State IL
ZIP 60649
Phone 773 947-7746
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/2/2023
Certificate Expiration Date 11/1/2025
Facility Type Physician Office
Lab Director MICHAEL T. FOREMAN

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