# LAKE HOSPITAL SYSTEM INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043275837
- **Authorized official:** MR. ROBERT TRACZ (CFO)
- **Authorized official phone:** (440) 354-1051

## Contact information

- **Practice address:** 7590 AUBURN RD, CONCORD TWP, OH 44077-9176
- **Practice address phone:** (440) 375-8152
- **Practice address fax:** (440) 354-1245
- **Mailing address:** PO BOX 781348, DETROIT, MI 48278
- **Mailing address phone:** (800) 354-1985
- **Mailing address fax:** (440) 354-4938

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 04/18/2006
- **Last updated:** 07/21/2022