14D2306015 CLIA NUMBER - AESTHETIC DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 14D2306015
  • Facility Name: AESTHETIC DERMATOLOGY
  • Facility Address: 1009 W FULTON MARKET
    CHICAGO, IL
    ZIP 60607
  • Facility Phone: 708 482-3213
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JONITH BREADON
  • NPI Number: 1225163967
  • Taxonomy: 261QM2500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2306015
LAB Type Physician Office
Facility Name AESTHETIC DERMATOLOGY
Street 1009 W FULTON MARKET
City CHICAGO
State IL
ZIP 60607
Phone 708 482-3213
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/11/2024
Certificate Expiration Date 6/10/2026
Facility Type Physician Office
Lab Director JONITH BREADON

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