Organization
LAKEVIEW DIAGNOSTIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRIDERIKI MANTIS (PRESIDENT)
(586) 293-8700
Entity
Organization
Contact information
Practice address
21519 HARPER AVE STE 107, SAINT CLAIR SHORES, MI 48080-2220
(586) 293-8700
Mailing address
27727 JOAN ST, SAINT CLAIR SHORES, MI 48081-1425
(586) 293-8700
(586) 293-8701
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
261QR0208X
Mobile Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
11/30/2006
Last updated
04/12/2024
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