LAK IMAGING INC , NPI 1821023391 — CHICAGO (IL)

NPI 1821023391

13+ Years Experience Organization

LAK IMAGING INC

07.12.2006
PROVIDER ENUMERATION DATE
04/20/2008
LAST UPDATE DATE
1821023391
NPI NUMBER

About LAK IMAGING INC

LAK IMAGING INC is a provider established in CHICAGO, IL. The NPI number of LAK IMAGING INC is 1821023391 and was assigned on 07.12.2006. The practitioners primary taxonomy code is: 2471S1302X with license number: RDMS 95906 .

Mailing address

  • City: CHICAGO
  • State: IL
  • Postal code: 606145273
  • Phone: 3124828730
  • Fax: 7739358087
  • Address: 1829 N CLEVELAND AVE
  • Address 2: UNIT C

Primary Practice Address

  • Region : CHICAGO, IL
  • NPI : 1821023391
  • Phone : 3124828730
  • Fax : 7739358087
  • Postalcode : 606145273
  • Address : 1829 N CLEVELAND AVE UNIT C

Additional identifiers

  • Identifier: 1632794
  • Code / Type : 1 - other
  • Identifier state : IL
  • Identifier issuer: BCBS RADIOLOGY ULTRASOUND

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Provider taxonomy - Radiologic Technologist

  • Taxonomy code: 2471S1302X
  • License number: RDMS 95906

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy group: 193400000X SINGLE SPECIALTY GROUP.

Contacts:

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  • LAK IMAGING INC
  • Address : 1829 N CLEVELAND AVE UNIT C
  • Region : CHICAGO, IL
  • NPI : 1821023391
  • Phone : 3124828730
  • Fax : 7739358087
  • Postalcode : 606145273

Authorized official :

{:AUTHORIZED_OFFICIAL_FIRST_NAME:} {:AUTHORIZED_OFFICIAL_MIDDLE_NAME:} {:AUTHORIZED_OFFICIAL_LAST_NAME:}
  • Phone : 3124828730
  • Title or position : PRESIDENT
  • Credentials : RDMS

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address1829 N CLEVELAND AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location AddressUNIT C
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameCHICAGO
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameIL
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code606145273
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number3124828730
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number7739358087
The fax number associated with the location address of the provider being identified.
NPI1821023391
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 12471S1302X
Provider Enumeration Date07.12.2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated04/20/2008
The date that a record was last updated or changed.
Entity TypeOrganization
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)LAK IMAGING INC
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address1829 N CLEVELAND AVE
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Second Line Business Mailing AddressUNIT C
The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
Provider Business Mailing Address City NameCHICAGO
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameIL
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code606145273
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number3124828730
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number7739358087
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Authorized Official Last NameKOULIEV
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameLARISSA
The first name of the authorized official
Authorized Official Title or PositionPRESIDENT
The title or position of the authorized official
Authorized Official Credential TextRDMS
Authorized Official Credential Text
Authorized Official Telephone Number3124828730
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code #12471S1302X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Radiologic Technologist
Provider License Number 1RDMS 95906
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 11632794
Other Provider Identifier #1
Other Provider Identifier Type 11
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1IL
Other Provider Identifier State #1
Other Provider Identifier Issuer 1BCBS RADIOLOGY ULTRASOUND
Other Provider Identifier Issuer #1
X

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