14D2204064 CLIA NUMBER - RONNIE MANDAL DO SC

Laboratory Demographics

  • CLIA Code: 14D2204064
  • Facility Name: RONNIE MANDAL DO SC
  • Facility Address: 2740 W FOSTER AVE - STE 101
    CHICAGO, IL
    ZIP 60625
  • Facility Phone: 773 545-9500
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RONNIE MANDAL
  • NPI Number: 1790233609
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D2204064
LAB Type Physician Office
Facility Name RONNIE MANDAL DO SC
Street 2740 W FOSTER AVE - STE 101
City CHICAGO
State IL
ZIP 60625
Phone 773 545-9500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/8/2024
Certificate Expiration Date 12/7/2026
Facility Type Physician Office
Lab Director RONNIE MANDAL

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