Provider Demographics
NPI:1780198382
Name:LAKES RADIOLOGY II INC
Entity Type:Organization
Organization Name:LAKES RADIOLOGY II INC
Other - Org Name:C & L IMAGING INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP / ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:CARLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PLAISUME
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?:Yes
Parent Organization LBN:LAKES RADIOLOGY II INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-20
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC98472085R0202X
261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Multi-Specialty