14D2063313 CLIA NUMBER - GYNECOLOGY INSTITUTE OF CHICAGO, LTD

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Laboratory Demographics

CLIA Number: 14D2063313

Facility Name: GYNECOLOGY INSTITUTE OF CHICAGO, LTD

Facility Address:
1147 S WABASH, STE 200
CHICAGO, IL
ZIP 60605
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Facility Phone Number: 312 929-9191

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1235573197

Taxonomy: 261QM2500X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

CLIA Record

Field Name	Field Value
CLIA Number	14D2063313
LAB Type	Physician Office
Facility Name	GYNECOLOGY INSTITUTE OF CHICAGO, LTD
Street	1147 S WABASH, STE 200
City	CHICAGO
State	IL
ZIP	60605
Phone	312 929-9191
CertificateType	4
CertificateEffectiveDate	7/31/2023
CertificateExpirationDate	7/30/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024