Healthcare Provider Details

I. General information

NPI: 1780198382
Provider Name (Legal Business Name): LAKES RADIOLOGY II INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N CONGRESS AVE STE 230
DELRAY BEACH FL
33445-3428
US

IV. Provider business mailing address

600 N CONGRESS AVE STE 230
DELRAY BEACH FL
33445-3428
US

V. Phone/Fax

Practice location:
  • Phone: 561-299-0003
  • Fax:
Mailing address:
  • Phone: 561-299-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberHCC9847
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARLINE PLAISUME
Title or Position: VP / ADMIN
Credential:
Phone: 954-709-0665