14D2136899 CLIA NUMBER - IRVING PARK DIALYSIS

Laboratory Demographics

  • CLIA Code: 14D2136899
  • Facility Name: IRVING PARK DIALYSIS
  • Facility Address: 4323 N PULASKI ROAD
    CHICAGO, IL
    ZIP 60641
  • Facility Phone: 773 279-8714
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: GLORIA J. NO MD
  • NPI Number: 1821507674
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2136899
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name IRVING PARK DIALYSIS
Street 4323 N PULASKI ROAD
City CHICAGO
State IL
ZIP 60641
Phone 773 279-8714
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/18/2025
Certificate Expiration Date 9/17/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director GLORIA J. NO MD

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