Provider Demographics
NPI:1861693079
Name:INTERNATIONAL CRYOGENICS, INC.
Entity type:Organization
Organization Name:INTERNATIONAL CRYOGENICS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-397-8449
Mailing Address - Street 1:32121 WOODWARD AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6237
Mailing Address - Country:US
Mailing Address - Phone:248-397-8449
Mailing Address - Fax:248-397-8392
Practice Address - Street 1:32121 WOODWARD AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6237
Practice Address - Country:US
Practice Address - Phone:248-397-8449
Practice Address - Fax:248-397-8392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23D0362829291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory