# LAKESHORE P.E.T IMAGING, LLC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790870699
- **Authorized official:** NEELAM S AUNG (OFFICE MANAGER)
- **Authorized official phone:** (708) 499-9700

## Contact information

- **Practice address:** 4932 W 95TH ST, OAK LAWN, IL 60453-2504
- **Practice address phone:** (708) 499-9700
- **Practice address fax:** (708) 499-9797
- **Mailing address:** 4932 W 95TH ST, OAK LAWN, IL 60453-2504
- **Mailing address phone:** (708) 499-9700
- **Mailing address fax:** (708) 499-9797

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/04/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 01633190 | BCBS | IL |