Provider Demographics
NPI:1760528327
Name:LAKES RADIOLOGY II INC
Entity Type:Organization
Organization Name:LAKES RADIOLOGY II INC
Other - Org Name:C & L IMAGING CENTER INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LOSAIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:BIEN-AMIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-709-0665
Mailing Address - Street 1:600 N CONGRESS AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-3428
Mailing Address - Country:US
Mailing Address - Phone:561-299-0003
Mailing Address - Fax:
Practice Address - Street 1:600 N CONGRESS AVE STE 230
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-3428
Practice Address - Country:US
Practice Address - Phone:561-299-0003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085R0202X
FLP06000108409261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP06000108409OtherP06000108409