14D2109533 CLIA NUMBER - ADVOCATE CLINIC CHICAGO KING DR

Laboratory Demographics

  • CLIA Code: 14D2109533
  • Facility Name: ADVOCATE CLINIC CHICAGO KING DR
  • Facility Address: 3405 S KING DR
    CHICAGO, IL
    ZIP 60616
  • Facility Phone: 773 295-3101
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: VERNDALE SHELDOU
  • NPI Number: 1639111933
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2109533
LAB Type Physician Office
Facility Name ADVOCATE CLINIC CHICAGO KING DR
Street 3405 S KING DR
City CHICAGO
State IL
ZIP 60616
Phone 773 295-3101
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/26/2024
Certificate Expiration Date 2/25/2026
Facility Type Physician Office
Lab Director VERNDALE SHELDOU

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This page was last updated on: 6/4/2025