14D2310258 CLIA NUMBER - LOCAL MD

Laboratory Demographics

  • CLIA Code: 14D2310258
  • Facility Name: LOCAL MD
  • Facility Address: 4165 N WATER ST
    DECATUR, IL
    ZIP 62526
  • Facility Phone: 708 922-0911
  • Facility Type: Other - URGENT CARE
  • Facility Type: Waiver
  • Lab Director: NOORUN KHAN
  • NPI Number: 1215407812
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D2310258
LAB Type Other - URGENT CARE
Facility Name LOCAL MD
Street 4165 N WATER ST
City DECATUR
State IL
ZIP 62526
Phone 708 922-0911
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/29/2024
Certificate Expiration Date 8/28/2026
Facility Type Other - URGENT CARE
Lab Director NOORUN KHAN

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