14D2065347 CLIA NUMBER - VILLAGE DOCTOR LTD

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Laboratory Demographics

CLIA Number: 14D2065347

Facility Name: VILLAGE DOCTOR LTD

Facility Address:
2323 W CHICAGO AVE
CHICAGO, IL
ZIP 60622
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Facility Phone Number: (773) 276-8600

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1982814992

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2065347
LAB Type	PHYSICIAN OFFICE
Facility Name	VILLAGE DOCTOR LTD
Street	2323 W CHICAGO AVE
City	CHICAGO
State	IL
ZIP	60622
Phone	(773) 276-8600

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