14D2192109 CLIA NUMBER - MD2 CHICAGO

Laboratory Demographics

  • CLIA Code: 14D2192109
  • Facility Name: MD2 CHICAGO
  • Facility Address: 676 N MICHIGAN AVENUE, STE 3120
    CHICAGO, IL
    ZIP 60611
  • Facility Phone: 312 780-2301
  • Facility Type: Other - PRIVATE PHYSICIANS OFFICE
  • Facility Type: Waiver
  • Lab Director: JOSEPH J. HENNESSY
  • NPI Number: 1568742542
  • Taxonomy: 302F00000X - Exclusive Provider Organization

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CLIA Record

Field Name Field Value
CLIA Number 14D2192109
LAB Type Other - PRIVATE PHYSICIANS OFFICE
Facility Name MD2 CHICAGO
Street 676 N MICHIGAN AVENUE, STE 3120
City CHICAGO
State IL
ZIP 60611
Phone 312 780-2301
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/4/2024
Certificate Expiration Date 9/3/2026
Facility Type Other - PRIVATE PHYSICIANS OFFICE
Lab Director JOSEPH J. HENNESSY

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