14D2262900 CLIA NUMBER - PRIME HEALTH SYSTEM INC

Laboratory Demographics

  • CLIA Code: 14D2262900
  • Facility Name: PRIME HEALTH SYSTEM INC
  • Facility Address: 1030 N CLARK ST - STE 647
    CHICAGO, IL
    ZIP 60610
  • Facility Phone: 847 213-1124
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ISSAM MAATOUK
  • NPI Number: 1861137135
  • Taxonomy: 202D00000X - Integrative Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D2262900
LAB Type Physician Office
Facility Name PRIME HEALTH SYSTEM INC
Street 1030 N CLARK ST - STE 647
City CHICAGO
State IL
ZIP 60610
Phone 847 213-1124
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/21/2024
Certificate Expiration Date 6/20/2026
Facility Type Physician Office
Lab Director ISSAM MAATOUK

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