Provider Demographics
NPI:1386790889
Name:LAKES RADIOLOGY INC
Entity type:Organization
Organization Name:LAKES RADIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARRIAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-231-1115
Mailing Address - Street 1:14575 NW 77TH AVE STE 100-200
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2547
Mailing Address - Country:US
Mailing Address - Phone:305-231-1115
Mailing Address - Fax:305-231-1116
Practice Address - Street 1:14575 NW 77TH AVE STE 100-200
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2547
Practice Address - Country:US
Practice Address - Phone:305-231-1115
Practice Address - Fax:305-231-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC43282085R0202X
247100000X, 2471B0102X, 2471C3401X, 2471C3402X, 2471M1202X, 2471M2300X, 2471N0900X, 2471S1302X, 2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Not Answered247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty
Not Answered2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone DensitometryGroup - Multi-Specialty
Not Answered2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed TomographyGroup - Multi-Specialty
Not Answered2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Multi-Specialty
Not Answered2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Multi-Specialty
Not Answered2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammographyGroup - Multi-Specialty
Not Answered2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine TechnologyGroup - Multi-Specialty
Not Answered2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
Not Answered2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL212587OtherMULTIPLAN
FLLRI 1000OtherDOCTORS CARE
FLSG073549OtherVISTA
FL1044429OtherCARE PLUS
FL222795OtherHEALTHEASE STAYWELL
FLV2807OtherBLUE CROSS BLUE SHIELD
FL3964OtherTOTAL HEALTH CHOICE
FL4193759OtherGHI
FL001W3OtherPREFERRED CARE PARTNERS
FL293269OtherAVMED
FL119846600Medicaid
FL7025163OtherSUNCOAST PHYSICIAN
FL48625OtherNEIGHBORHOOD
FL53845OtherHEALTHSUN
FL5533957OtherCCN NETWORK
FL212587OtherMULTIPLAN