Organization
LAKESHORE P.E.T IMAGING, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NEELAM S AUNG (OFFICE MANAGER)
(708) 499-9700
Entity
Organization
Contact information
Practice address
4932 W 95TH ST, OAK LAWN, IL 60453-2504
(708) 499-9700
(708) 499-9797
Mailing address
4932 W 95TH ST, OAK LAWN, IL 60453-2504
(708) 499-9700
(708) 499-9797
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01633190
BCBS
IL
Enumeration date
10/04/2006
Last updated
08/22/2020
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