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General NPI Number Information
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NPI Number | 1922175082
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Entity Type | Organization
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Legal Business Name | LAKEVIEW DIAGNOSTIC SERVICES
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 04/12/2024
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Provider Practice Location Address
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Address Line | 21519 HARPER AVE STE 107
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-2220
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Country | US
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Telephone | 586-293-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 27727 JOAN ST
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-1425
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Country | US
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Telephone | 586-293-8700
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Fax | 586-293-8701
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Authorized Official
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Title or Position | PRESIDENT
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Name | FRIDERIKI MANTIS
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Credential |
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Telephone | 586-293-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease 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 | 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 #3
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number |
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License Number State |
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