LAKELAND NUCLEAR IMAGING, INC. — NPI 1619933546 (Licensed & Credentialed Allopathic & Osteopathic Physicians — Nuclear Medicine, Nuclear Imaging & Therapy in NILES, MI)

CMS-1500 Box 24J / 33a • NPI

1619933546

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

207UN0902X (CMS 36)

Licensed & Credentialed Allopathic & Osteopathic Physicians — Nuclear Medicine, Nuclear Imaging & Therapy

Box 32 Service Location & ZIP+4

122 GRANT ST, NILES, MI, 49120-2281

✓ 9-Digit EDI 837 ZIP+4 (49120-2281)

Practice Phone & Referral Fax

(269) 684-0295

Fax: (269) 684-0189

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1619933546 (LAKELAND NUCLEAR IMAGING, INC.) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1619933546` (NPI-2 Organization / Facility)
Provider / Legal Name	LAKELAND NUCLEAR IMAGING, INC.
Plain-English Specialty	Licensed & Credentialed Allopathic & Osteopathic Physicians — Nuclear Medicine, Nuclear Imaging & Therapy NUCC Code: `207UN0902X` (Nuclear Medicine, Nuclear Imaging & Therapy)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	122 GRANT ST, NILES, MI, 49120-2281
Practice Telephone / Fax	Tel: (269) 684-0295 \| Fax: (269) 684-0189
Administrative Mailing Address	6720 RED ARROW HWY, COLOMA, MI, 49038-9703
Enumeration & Last Sync	Enumerated: 2006-04-20 \| CMS Record Updated: 2007-08-20
Authorized Official	DENNIS MACK (Vice President of Facility & Suppor)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

122 GRANT ST, NILES, MI, 49120-2281

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Plain-English Taxonomy & CMS Crosswalk (207UN0902X)

What Does Taxonomy Code 207UN0902X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 207UN0902X translates to:
"Licensed & Credentialed Allopathic & Osteopathic Physicians — Nuclear Medicine, Nuclear Imaging & Therapy"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 36 (Physician/Nuclear Medicine)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Nuclear Medicine, Nuclear Imaging & Therapy for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (LAKELAND NUCLEAR IMAGING, INC.)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`207UN0902X` — Nuclear Medicine, Nuclear Imaging & Therapy Plain English: Licensed & Credentialed Allopathic & Osteopathic Physicians — Nuclear Medicine, Nuclear Imaging & Therapy	State: MI \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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LAKELAND NUCLEAR IMAGING, INC. (NPI #1619933546)