Organization
LAK IMAGING INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARISSA KOULIEV RDMS (PRESIDENT)
(312) 482-8730
Entity
Organization
Contact information
Practice address
1829 N CLEVELAND AVE, UNIT C, CHICAGO, IL 60614-5273
(312) 482-8730
(773) 935-8087
Mailing address
1829 N CLEVELAND AVE, UNIT C, CHICAGO, IL 60614-5273
(312) 482-8730
(773) 935-8087
Taxonomy
Speciality
Code
Description
License number
State
2471S1302X
Sonography Radiologic Technologist
Primary
RDMS 95906
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01632794
BCBS RADIOLOGY ULTRASOUND
IL
Enumeration date
07/12/2006
Last updated
08/22/2020
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