14D2267461 CLIA NUMBER - SOLLEY'S MEDICAL GROUP

Laboratory Demographics

CLIA Number: 14D2267461

Facility Name: SOLLEY'S MEDICAL GROUP

Facility Address:
4239 W 95TH ST
OAK LAWN, IL
ZIP 60453
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Facility Phone Number: 708 529-0188

Facility Type: Ancillary Testing Site in Health Care Center

Certificate Type: Waiver

NPI Number: 1487238390

Taxonomy: 101YA0400X - Counselor

CLIA Record

Field Name	Field Value
CLIA Number	14D2267461
LAB Type	Ancillary Testing Site in Health Care Center
Facility Name	SOLLEY'S MEDICAL GROUP
Street	4239 W 95TH ST
City	OAK LAWN
State	IL
ZIP	60453
Phone	708 529-0188
CertificateType	4
CertificateEffectiveDate	8/25/2022
CertificateExpirationDate	8/24/2024
FacilityType	Waiver

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