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14D2188757 CLIA NUMBER - BROADWAY MEDICAL CARE S C

Laboratory Demographics

CLIA Number: 14D2188757

Facility Name: BROADWAY MEDICAL CARE S C

Facility Address:
414 W LAKE ST
ADDISON, IL
ZIP 60101
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Facility Phone Number: 708 345-8960

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1710512165

Taxonomy: 207R00000X - Internal Medicine
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

CLIA Record

Field Name Field Value
CLIA Number 14D2188757
LAB Type Physician Office
Facility Name BROADWAY MEDICAL CARE S C
Street 414 W LAKE ST
City ADDISON
State IL
ZIP 60101
Phone 708 345-8960
CertificateType 4
CertificateEffectiveDate 7/21/2022
CertificateExpirationDate 7/20/2024
FacilityType Waiver

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