Medical Diagnostic Laboratory, INC
NPI #1699706770 in Belleville, Illinois
Provider Information
- NPI Number
- 1699706770
- Entity Type
- Organization
- Organization Name
- Medical Diagnostic Laboratory, INC
- Primary Specialty
- Clinical Medical Laboratory
- Enumeration Date
- Jul 6, 2006
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 45 SHEFFIELD DR
- City
- Belleville
- State
- Illinois
- ZIP Code
- 62223-3557
- Phone
- (618) 233-0522
Authorized Official
- Name
- MR. PAUL PONGPITOON, MT(ASCP) M.P.H.
- Title
- PRESIDENT
- Phone
- (618) 233-0522
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinical Medical Laboratory |
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