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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