14D2179864 CLIA NUMBER - INNOVATIVE PRIMARY CARE INNOVATIVE PLATINUM CARE

Laboratory Demographics

  • CLIA Code: 14D2179864
  • Facility Name: INNOVATIVE PRIMARY CARE INNOVATIVE PLATINUM CARE
  • Facility Address: 2418 N ASHLAND
    CHICAGO, IL
    ZIP 60614
  • Facility Phone: 773 900-8330
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RAHUL KHARE M D
  • NPI Number: 1104237114
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2179864
LAB Type Physician Office
Facility Name INNOVATIVE PRIMARY CARE INNOVATIVE PLATINUM CARE
Street 2418 N ASHLAND
City CHICAGO
State IL
ZIP 60614
Phone 773 900-8330
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/3/2024
Certificate Expiration Date 3/2/2026
Facility Type Physician Office
Lab Director RAHUL KHARE M D

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