Organization
LAKESIDE EDX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS WINGER (MEMBER)
(800) 416-1767
Entity
Organization
Contact information
Practice address
495 GRAND BLVD STE 206, MIRAMAR BEACH, FL 32550-1897
(800) 416-1767
Mailing address
495 GRAND BLVD STE 206, MIRAMAR BEACH, FL 32550-1897
(800) 416-1767
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
05/11/2021
Last updated
05/11/2021
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