14D2099737 CLIA NUMBER - CHICAGO HEALTH MEDICAL GROUP RESILIENCE HEALTHCARE - LAKEFRONT MED ASSOC LLC

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Laboratory Demographics

CLIA Number: 14D2099737

Facility Name: CHICAGO HEALTH MEDICAL GROUP RESILIENCE HEALTHCARE - LAKEFRONT MED ASSOC LLC

Facility Address:
6201 N BROADWAY
CHICAGO, IL
ZIP 60660
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Facility Phone Number: 773 796-3400

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1245711027

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	14D2099737
LAB Type	Physician Office
Facility Name	CHICAGO HEALTH MEDICAL GROUP RESILIENCE HEALTHCARE - LAKEFRONT MED ASSOC LLC
Street	6201 N BROADWAY
City	CHICAGO
State	IL
ZIP	60660
Phone	773 796-3400
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