Basic Information
| Provider Information | |||||||||
| NPI: | 1861815748 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAKEWAY DIAGNOSTICS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13161 MISTY WILLOW DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770705635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2819705900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16131 N ELDRIDGE PKWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | TOMBALL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773779130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2819705900 | ||||||||
| FaxNumber: | 8449705914 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2014 | ||||||||
| LastUpdateDate: | 01/29/2018 | ||||||||
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| AuthorizedOfficialLastName: | KUHNS | ||||||||
| AuthorizedOfficialFirstName: | CRAIG | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2819705900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.