14D2060834 CLIA NUMBER - NORTHSIDE MEDICAL CENTER

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Laboratory Demographics

CLIA Number: 14D2060834

Facility Name: NORTHSIDE MEDICAL CENTER

Facility Address:
2656 W MONTROSE AVE, STE 100
CHICAGO, IL
ZIP 60618
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Facility Phone Number: (773) 267-1304

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1750769832

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2060834
LAB Type	PHYSICIAN OFFICE
Facility Name	NORTHSIDE MEDICAL CENTER
Street	2656 W MONTROSE AVE, STE 100
City	CHICAGO
State	IL
ZIP	60618
Phone	(773) 267-1304

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This page was last updated on: 5/11/2023