| NPI | 1528870243 |
|---|---|
| Doing Business As | LAKESIDE CT |
| Entity Type | Organization |
| Authorized Contact | DANIEL EDWARD HEINER Md/Partner 928-505-5555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology |
| Enumeration Date | 2025-01-21 |
| Last Update Date | 2025-01-21 |