Healthcare Provider Details

I. General information

NPI: 1023023686
Provider Name (Legal Business Name): LAKEPOINTE RADIOLOGY, P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 12/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

468 CADIEUX RD
GROSSE POINTE MI
48230-1507
US

IV. Provider business mailing address

PO BOX 1108 ATTN: BARB SIMMONS
ANN ARBOR MI
48106-1108
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-1630
  • Fax: 313-343-1631
Mailing address:
  • Phone: 734-677-7400
  • Fax: 734-677-7407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ARUN G PATEL
Title or Position: PRESIDENT
Credential: MD
Phone: 313-343-1562