14D2155164 CLIA NUMBER - EUGENE POMERANETS M D S C

Laboratory Demographics

CLIA Number: 14D2155164

Facility Name: EUGENE POMERANETS M D S C

Facility Address:
500 PARK AVE - STE 104
LAKE VILLA, IL
ZIP 60046
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Facility Phone Number: 847 245-8700

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1770579005

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	14D2155164
LAB Type	Physician Office
Facility Name	EUGENE POMERANETS M D S C
Street	500 PARK AVE - STE 104
City	LAKE VILLA
State	IL
ZIP	60046
Phone	847 245-8700
CertificateType	4
CertificateEffectiveDate	9/25/2022
CertificateExpirationDate	9/24/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024