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General NPI Number Information
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NPI Number | 1790053981
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Entity Type | Organization
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Legal Business Name | LAKES INTERVENTIONAL RADIOLOGY CORP
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Dates
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Enumeration Date | 12/02/2011
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 1380 NE MIAMI GARDENS DR STE 240
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33179-4750
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Country | US
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Telephone | 305-907-6191
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Fax | 305-907-6192
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Provider Business Mailing Address
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Address Line | 16855 NE 2ND AVE STE 305
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-1744
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Country | US
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Telephone | 305-907-6191
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Fax | 305-907-6192
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MOISES ROIZENTAL
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Credential |
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Telephone | 305-907-6191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | OSR807
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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