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General NPI Number Information
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NPI Number | 1760528327
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Entity Type | Organization
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Legal Business Name | LAKES RADIOLOGY II INC
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 06/02/2023
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Provider Practice Location Address
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Address Line | 600 N CONGRESS AVE STE 230
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City | DELRAY BEACH
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State | FL
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Zip | 33445-3428
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Country | US
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Telephone | 561-299-0003
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Fax |
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Provider Business Mailing Address
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Address Line | 600 N CONGRESS AVE STE 230
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City | DELRAY BEACH
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State | FL
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Zip | 33445-3428
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Country | US
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Telephone | 561-299-0003
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. LOSAIRE BIEN-AMIE
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Credential |
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Telephone | 954-709-0665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | P06000108409
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License Number State | FL
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