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Organization
LAKE HOSPITAL SYSTEM, INC.
Active
Organization
LAKE HOSPITAL SYSTEM, INC.
Active
Other names
PrimeHealth Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT TRACZ (CHIEF FINANCIAL OFFICER)
(440) 354-1642
Entity
Organization
Contact information
Practice address
29804 LAKESHORE BLVD, WILLOWICK, OH 44095-4611
(440) 354-1899
(440) 354-1089
Mailing address
PO BOX 714328, COLUMBUS, OH 43271-4328
(800) 354-1985
(440) 350-4938
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
01/07/2009
Last updated
01/07/2009
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