14D2060868 CLIA NUMBER - TIESENGA SURGICAL ASSOCIATES S C

Laboratory Demographics

  • CLIA Code: 14D2060868
  • Facility Name: TIESENGA SURGICAL ASSOCIATES S C
  • Facility Address: 1950 N HARLEM
    ELMWOOD PARK, IL
    ZIP 60707
  • Facility Phone: 708 453-6800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: FREDERICK M. TIESENGA
  • NPI Number: 1801876586
  • Taxonomy: 208600000X - Surgery

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CLIA Record

Field Name Field Value
CLIA Number 14D2060868
LAB Type Physician Office
Facility Name TIESENGA SURGICAL ASSOCIATES S C
Street 1950 N HARLEM
City ELMWOOD PARK
State IL
ZIP 60707
Phone 708 453-6800
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 FREDERICK M. TIESENGA

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