Provider Demographics
NPI:1922419340
Name:KKL RADIOLOGY, PLLC
Entity Type:Organization
Organization Name:KKL RADIOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MONIK
Authorized Official - Middle Name:
Authorized Official - Last Name:LALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-945-5450
Mailing Address - Street 1:3781 INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:ORCHARD LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48324-1626
Mailing Address - Country:US
Mailing Address - Phone:248-225-6909
Mailing Address - Fax:
Practice Address - Street 1:3781 INDIAN TRL
Practice Address - Street 2:
Practice Address - City:ORCHARD LAKE
Practice Address - State:MI
Practice Address - Zip Code:48324-1626
Practice Address - Country:US
Practice Address - Phone:248-225-6909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-20
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010825682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty