14D2252287 CLIA NUMBER - 2001-15 N PARKSIDE LLC

Laboratory Demographics

  • CLIA Code: 14D2252287
  • Facility Name: 2001-15 N PARKSIDE LLC
  • Facility Address: 405 N WABASH AVE - STE P2A
    CHICAGO, IL
    ZIP 60611
  • Facility Phone: 312 955-4005
  • Facility Type: Independent
  • Facility Type: Waiver
  • Lab Director: HUMERA KHAN
  • NPI Number: 1518607696
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2252287
LAB Type Independent
Facility Name 2001-15 N PARKSIDE LLC
Street 405 N WABASH AVE - STE P2A
City CHICAGO
State IL
ZIP 60611
Phone 312 955-4005
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/10/2024
Certificate Expiration Date 2/9/2026
Facility Type Independent
Lab Director HUMERA KHAN

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