14D2067991 CLIA NUMBER - ADVANCED HEART GROUP

Laboratory Demographics

  • CLIA Code: 14D2067991
  • Facility Name: ADVANCED HEART GROUP
  • Facility Address: 19550 GOVERNORS HWY, STE 2900
    FLOSSMOOR, IL
    ZIP 60422
  • Facility Phone: 708 331-2200
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: PONNAMBALAM S. SUNDRAM M D
  • NPI Number: 1518945989
  • Taxonomy: 207RC0000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D2067991
LAB Type Physician Office
Facility Name ADVANCED HEART GROUP
Street 19550 GOVERNORS HWY, STE 2900
City FLOSSMOOR
State IL
ZIP 60422
Phone 708 331-2200
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/25/2023
Certificate Expiration Date 10/24/2025
Facility Type Physician Office
Lab Director PONNAMBALAM S. SUNDRAM M D

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