Organization
MEDICAL INSTRUMENTATION CORP
Active
Organization
MEDICAL INSTRUMENTATION CORP
Active
Other names
COAGULATION CONSULTANTS LAB
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY BRACE PHD (DIRECTOR)
(847) 954-1134
Entity
Organization
Contact information
Practice address
1640 ELK BLVD, DES PLAINES, IL 60016-4722
(847) 954-1134
(847) 954-1136
Mailing address
1640 ELK BLVD, DES PLAINES, IL 60016-4722
(847) 954-1134
(847) 954-1136
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
14D0413340
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14D0413340
CLIA
IL
Enumeration date
03/05/2007
Last updated
03/14/2022
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