14D2270251 CLIA NUMBER - PRAIRIE DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 14D2270251
  • Facility Name: PRAIRIE DERMATOLOGY
  • Facility Address: 1015 S MERCER AVE - SUITE GF7
    BLOOMINGTON, IL
    ZIP 61701
  • Facility Phone: 309 660-8442
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: MICHAEL T. GINNETTI
  • NPI Number: 1881333680
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 14D2270251
LAB Type Physician Office
Facility Name PRAIRIE DERMATOLOGY
Street 1015 S MERCER AVE - SUITE GF7
City BLOOMINGTON
State IL
ZIP 61701
Phone 309 660-8442
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 12/31/2024
Certificate Expiration Date 12/30/2026
Facility Type Physician Office
Lab Director MICHAEL T. GINNETTI

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