14D2299279 CLIA NUMBER - DERM INSTITUTE OF CHICAGO

Laboratory Demographics

  • CLIA Code: 14D2299279
  • Facility Name: DERM INSTITUTE OF CHICAGO
  • Facility Address: 1945 W WILSON AVE - STE 6119
    CHICAGO, IL
    ZIP 60640
  • Facility Phone: 312 319-1978
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JORDAN C. CARQUEVILLE
  • NPI Number: 1710531330
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 14D2299279
LAB Type Physician Office
Facility Name DERM INSTITUTE OF CHICAGO
Street 1945 W WILSON AVE - STE 6119
City CHICAGO
State IL
ZIP 60640
Phone 312 319-1978
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/16/2024
Certificate Expiration Date 2/15/2026
Facility Type Physician Office
Lab Director JORDAN C. CARQUEVILLE

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