Lakeside Diagnostic Imaging Center, LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

LAKESIDE DIAGNOSTIC IMAGING CENTER, LLC

Practice address

4601 N Oakland Ave
Shorewood, WI 53211-1232

Phone

(414) 964-4601

Fax

(414) 964-4616

NPI assigned

Jun 12, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bruce W. Cardone, MD

Title

Authorized Official

Phone

(414) 964-4601

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206403200000",
    "number": "1639111016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 N OAKLAND AVE",
            "city": "SHOREWOOD",
            "state": "WI",
            "postal_code": "532111232",
            "telephone_number": "414-964-4601",
            "fax_number": "414-964-4616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 N OAKLAND AVE",
            "city": "SHOREWOOD",
            "state": "WI",
            "postal_code": "532111232",
            "telephone_number": "414-964-4601",
            "fax_number": "414-964-4616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE DIAGNOSTIC IMAGING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2008-03-25",
        "status": "A",
        "authorized_official_last_name": "CARDONE",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "414-964-4601",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21258300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gabriella Caitrin Kline, OTR
• Anna Koeck, O.D.
• Kyle Konkol, LPC-IT
• Carol Kuhlow, MS LPC
• Rachel Ladin
• Lakeside Diagnostic Imaging LLC
• Catherine G Larosa-Bell, LPC-IT
• Kristen Anne Larson, MS/CCC-SLP
• Laurie Reisener Counseling Services, LLC
• Hayley Leair, REGISTERED NURSE

• Diagnostic Radiology Physician in Shorewood, WI
• Providers in Shorewood, WI by specialty
• Diagnostic Radiology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.