Healthcare Provider Details

I. General information

NPI: 1245396969
Provider Name (Legal Business Name): LAKESIDE MRI & DIAGNOSTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 11/17/2022
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17360 HIGHWAY 3
WEBSTER TX
77598-4133
US

IV. Provider business mailing address

PO BOX 890313
HOUSTON TX
77289-0313
US

V. Phone/Fax

Practice location:
  • Phone: 281-338-5575
  • Fax: 281-554-8407
Mailing address:
  • Phone: 281-338-5575
  • Fax: 281-554-8407

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 Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAMEER ABDULHUSSEIN
Title or Position: PRESIDENT
Credential:
Phone: 833-633-7331