# LAKEVIEW DIAGNOSTIC SERVICES

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

## Provider details

- **NPI number:** 1922175082
- **Authorized official:** FRIDERIKI MANTIS (PRESIDENT)
- **Authorized official phone:** (586) 293-8700

## Contact information

- **Practice address:** 21519 HARPER AVE STE 107, SAINT CLAIR SHORES, MI 48080-2220
- **Practice address phone:** (586) 293-8700
- **Mailing address:** 27727 JOAN ST, SAINT CLAIR SHORES, MI 48081-1425
- **Mailing address phone:** (586) 293-8700
- **Mailing address fax:** (586) 293-8701

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 2085R0202X | Diagnostic Radiology Physician | — | NULL | — |
| 261QR0208X | Mobile Radiology Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/30/2006
- **Last updated:** 04/12/2024