14D2169713 CLIA NUMBER - BEACH PARK DIALYSIS

Laboratory Demographics

  • CLIA Code: 14D2169713
  • Facility Name: BEACH PARK DIALYSIS
  • Facility Address: 3119 N LEWIS AVE
    WAUKEGAN, IL
    ZIP 60087
  • Facility Phone: 847 782-8250
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: OMAR S. DALLOUL M D
  • NPI Number: 1942247093
  • Taxonomy: 3416L0300X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 14D2169713
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name BEACH PARK DIALYSIS
Street 3119 N LEWIS AVE
City WAUKEGAN
State IL
ZIP 60087
Phone 847 782-8250
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/25/2025
Certificate Expiration Date 7/24/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director OMAR S. DALLOUL M D

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