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Organization
LAKE HOSPITAL SYSTEM, INC.
Active
Organization
LAKE HOSPITAL SYSTEM, INC.
Active
Other names
LHPG Tyler Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT B TRACZ (CHIEF FINANCIAL OFFICER)
(440) 354-1642
Entity
Organization
Contact information
Practice address
7956 TYLER BLVD, MENTOR, OH 44060-4806
(440) 833-2010
(440) 833-2096
Mailing address
PO BOX 714328, COLUMBUS, OH 43271-4328
(440) 833-2020
(440) 833-2096
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
06/25/2010
Last updated
06/25/2010
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