Provider Demographics
NPI:1891782090
Name:LAKELAND RADIOLOGISTS LTD
Entity Type:Organization
Organization Name:LAKELAND RADIOLOGISTS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALDO
Authorized Official - Middle Name:C
Authorized Official - Last Name:RUFFOLO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:217-345-2100
Mailing Address - Street 1:907 W LINCOLN AVE
Mailing Address - Street 2:PO BOX 770
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-2413
Mailing Address - Country:US
Mailing Address - Phone:217-235-7701
Mailing Address - Fax:217-345-8366
Practice Address - Street 1:907 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-2413
Practice Address - Country:US
Practice Address - Phone:312-574-0076
Practice Address - Fax:888-453-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL615950Medicare ID - Type Unspecified