MEDICARE: LAKES IMAGING SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1376852178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKES IMAGING SERVICES INC

Provider Business Mailing Address
First Line	:	6001 NW 153RD ST STE 154
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6001 NW 153RD ST STE 154
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2447
Country	:	US
Telephone Number	:	305-818-7473
Fax Number	:	305-328-9629

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. ONSLAIDYS MACHIN
Credential	:
Telephone Number	:	786-333-1368

Provider Enumeration Date	:	09/28/2010
Last Update Date	:	07/08/2011

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