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General NPI Number Information
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NPI Number | 1477872125
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Entity Type | Organization
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Legal Business Name | LAKESIDE NEUROLOGY AND RADIOLOGY
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Dates
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Enumeration Date | 05/20/2010
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Last Update Date | 05/20/2010
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Provider Practice Location Address
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Address Line | 12673 S DIXIE HWY
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City | MIAMI
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State | FL
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Zip | 33156-5958
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Country | US
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Telephone | 800-416-1767
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Fax | 888-317-4206
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Provider Business Mailing Address
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Address Line | 2516 WAUKEGAN RD STE 386
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City | GLENVIEW
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State | IL
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Zip | 60025-1774
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Country | US
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Telephone | 800-416-1767
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Fax | 888-317-4206
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MR. THOMAS WINGER
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Credential |
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Telephone | 800-416-1767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | FL
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