14D2091991 CLIA NUMBER - NORTHWEST CHICAGO PRIMARY CARE SC

Laboratory Demographics

  • CLIA Code: 14D2091991
  • Facility Name: NORTHWEST CHICAGO PRIMARY CARE SC
  • Facility Address: 1100 LAKE ST, STE LL21
    OAK PARK, IL
    ZIP 60301
  • Facility Phone: 773 635-5700
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHARLEMAGNE G. GUERRERO MD
  • NPI Number: 1962760017
  • Taxonomy: 207R00000X - Internal Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 14D2091991
LAB Type Physician Office
Facility Name NORTHWEST CHICAGO PRIMARY CARE SC
Street 1100 LAKE ST, STE LL21
City OAK PARK
State IL
ZIP 60301
Phone 773 635-5700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/24/2025
Certificate Expiration Date 2/23/2027
Facility Type Physician Office
Lab Director CHARLEMAGNE G. GUERRERO MD

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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