14D2157333 CLIA NUMBER - IMAGINE M D, WEST LOOP

Laboratory Demographics

  • CLIA Code: 14D2157333
  • Facility Name: IMAGINE M D, WEST LOOP
  • Facility Address: 10 S RIVERSIDE PLAZA - STE 2225
    CHICAGO, IL
    ZIP 60606
  • Facility Phone: 312 374-5862
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ALEX J. LICKERMAN M D
  • NPI Number: 1437638574
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D2157333
LAB Type Physician Office
Facility Name IMAGINE M D, WEST LOOP
Street 10 S RIVERSIDE PLAZA - STE 2225
City CHICAGO
State IL
ZIP 60606
Phone 312 374-5862
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/5/2024
Certificate Expiration Date 11/4/2026
Facility Type Physician Office
Lab Director ALEX J. LICKERMAN M D

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