Provider Demographics
NPI:1821023391
Name:LAK IMAGING INC
Entity Type:Organization
Organization Name:LAK IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOULIEV
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS
Authorized Official - Phone:312-482-8730
Mailing Address - Street 1:1829 N CLEVELAND AVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5273
Mailing Address - Country:US
Mailing Address - Phone:312-482-8730
Mailing Address - Fax:773-935-8087
Practice Address - Street 1:1829 N CLEVELAND AVE
Practice Address - Street 2:UNIT C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5273
Practice Address - Country:US
Practice Address - Phone:312-482-8730
Practice Address - Fax:773-935-8087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RDMS 959062471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632794OtherBCBS RADIOLOGY ULTRASOUND
IL=========OtherUNICARE ANCILLARY
IL=========OtherAETNA
IL=========001Medicaid
IL=========OtherCIGNA
IL01632794OtherBCBS RADIOLOGY ULTRASOUND
IL=========OtherUNITEDHEALTHCARE
IL=========OtherHUMANA