| Organization Name: | GRAND LAKE IMAGING PC |
| NPI Number: | 1184684011 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KEVIN JAMES YUNT (PRESIDENT) |
| Mailing Address: | 1001 E 18th St Grove |
| State: | OK US |
| Postal Code: | 743442907 |
| Phone Number: | 9725260340 |
| Fax Number: | 9729961857 |
| NPI Enumeration Date: | 03/24/2006 |
| NPI Last Update Date: | 06/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085R0202X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Diagnostic Radiology |
| Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |