14D2103636 CLIA NUMBER - INNOVATIVE PLATINUM CARE

Laboratory Demographics

  • CLIA Code: 14D2103636
  • Facility Name: INNOVATIVE PLATINUM CARE
  • Facility Address: 2400 N ASHLAND AVE, STE 150
    CHICAGO, IL
    ZIP 60614
  • Facility Phone: 773 270-5600
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RAHUL K. KHARE MD
  • NPI Number: 1114397056
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D2103636
LAB Type Physician Office
Facility Name INNOVATIVE PLATINUM CARE
Street 2400 N ASHLAND AVE, STE 150
City CHICAGO
State IL
ZIP 60614
Phone 773 270-5600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/16/2025
Certificate Expiration Date 10/15/2027
Facility Type Physician Office
Lab Director RAHUL K. KHARE MD

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