14D2107762 CLIA NUMBER - NORTHSHORE UNIVERSITY HEALTHSYSTEM

Laboratory Demographics

  • CLIA Code: 14D2107762
  • Facility Name: NORTHSHORE UNIVERSITY HEALTHSYSTEM
  • Facility Address: 71 WAUKEGAN ROAD
    LAKE BLUFF, IL
    ZIP 60044
  • Facility Phone: 847 810-4975
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JASON WALDINGER MD
  • NPI Number: 1427061977
  • Taxonomy: 207L00000X - Anesthesiology

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CLIA Record

Field Name Field Value
CLIA Number 14D2107762
LAB Type Physician Office
Facility Name NORTHSHORE UNIVERSITY HEALTHSYSTEM
Street 71 WAUKEGAN ROAD
City LAKE BLUFF
State IL
ZIP 60044
Phone 847 810-4975
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 1/21/2024
Certificate Expiration Date 1/20/2026
Facility Type Physician Office
Lab Director JASON WALDINGER MD

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