Provider Demographics
NPI:1811224785
Name:LAKE COUNTY IMAGING, LLC
Entity Type:Organization
Organization Name:LAKE COUNTY IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:B
Authorized Official - Last Name:ANDROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-990-1141
Mailing Address - Street 1:712 S MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3279
Mailing Address - Country:US
Mailing Address - Phone:847-362-1848
Mailing Address - Fax:
Practice Address - Street 1:712 S MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3279
Practice Address - Country:US
Practice Address - Phone:847-362-1848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty