# LAKE COUNTY PAIN & DIAGNOSTIC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PATRICK T. BOYLAN, MD INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1497740617
- **Legal business name:** PATRICK T. BOYLAN, MD INC
- **Authorized official:** PATRICK T BOYLAN MD (OWNER / PHYSICIAN)
- **Authorized official phone:** (440) 205-9119

## Contact information

- **Practice address:** 8401 MENTOR AVE, STE A, MENTOR, OH 44060-5842
- **Practice address phone:** (440) 205-9119
- **Practice address fax:** (440) 205-9209
- **Mailing address:** 9485 MENTOR AVE STE 203, MENTOR, OH 44060-8723
- **Mailing address phone:** (440) 205-9119
- **Mailing address fax:** (440) 205-9209

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 0743A5 | OH | Yes |

## Other

- **Enumeration date:** 09/14/2005
- **Last updated:** 03/02/2020