14D2138226 CLIA NUMBER - NORTHWESTERN UNIVERSITY ISGMH MAIN OFFICES

Laboratory Demographics

  • CLIA Code: 14D2138226
  • Facility Name: NORTHWESTERN UNIVERSITY ISGMH MAIN OFFICES
  • Facility Address: 625 N MICHIGAN AVE 14-022
    CHICAGO, IL
    ZIP 60611
  • Facility Phone: 773 417-9772
  • Facility Type: Other - RESEARCH LAB
  • Facility Type: Waiver
  • Lab Director: RICHARD T. DAQUILA
  • NPI Number: 1144257387
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 14D2138226
LAB Type Other - RESEARCH LAB
Facility Name NORTHWESTERN UNIVERSITY ISGMH MAIN OFFICES
Street 625 N MICHIGAN AVE 14-022
City CHICAGO
State IL
ZIP 60611
Phone 773 417-9772
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/7/2024
Certificate Expiration Date 3/6/2026
Facility Type Other - RESEARCH LAB
Lab Director RICHARD T. DAQUILA

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