14D2298584 CLIA NUMBER - BLAKE MEDICAL CARE SC

Laboratory Demographics

  • CLIA Code: 14D2298584
  • Facility Name: BLAKE MEDICAL CARE SC
  • Facility Address: 131 E PARK AVE - STE 103
    LIBERTYVILLE, IL
    ZIP 60048
  • Facility Phone: 847 984-3290
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KATHERINE BLAKE
  • NPI Number: 1013663749
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D2298584
LAB Type Physician Office
Facility Name BLAKE MEDICAL CARE SC
Street 131 E PARK AVE - STE 103
City LIBERTYVILLE
State IL
ZIP 60048
Phone 847 984-3290
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/5/2024
Certificate Expiration Date 2/4/2026
Facility Type Physician Office
Lab Director KATHERINE BLAKE

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