14D2275641 CLIA NUMBER - LAKESIDE DERMATOLOGY, A FOREFRONT DERM PRACTICE FOREFRONT DERMATOLOGY PRACTICE

Laboratory Demographics

  • CLIA Code: 14D2275641
  • Facility Name: LAKESIDE DERMATOLOGY, A FOREFRONT DERM PRACTICE FOREFRONT DERMATOLOGY PRACTICE
  • Facility Address: 1240 N MILWAUKEE AVE - STE B
    LIBERTYVILLE, IL
    ZIP 60048
  • Facility Phone: 920 663-9008
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MARTHA P. ARROYO
  • NPI Number: 1841902038
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 14D2275641
LAB Type Physician Office
Facility Name LAKESIDE DERMATOLOGY, A FOREFRONT DERM PRACTICE FOREFRONT DERMATOLOGY PRACTICE
Street 1240 N MILWAUKEE AVE - STE B
City LIBERTYVILLE
State IL
ZIP 60048
Phone 920 663-9008
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 1/25/2025
Certificate Expiration Date 1/24/2027
Facility Type Physician Office
Lab Director MARTHA P. ARROYO

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