{
"Npi": {
"NPI": "1760528327",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LAKES RADIOLOGY II INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "600 N CONGRESS AVE STE 230",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DELRAY BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33445-3428",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "561-299-0003",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "600 N CONGRESS AVE STE 230",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DELRAY BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33445-3428",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "561-299-0003",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/30/2007",
"LastUpdateDate": "06/02/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BIEN-AMIE",
"AuthorizedOfficialFirstName": "LOSAIRE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "954-709-0665",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "2085R0202X",
"TaxonomyName": "Diagnostic Radiology Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "P06000108409",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}