# LAKE HOSPITAL SYSTEM

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lake Health Physician Group Electrophysiology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710295829
- **Authorized official:** MR. ROBERT TRACZ (CFO)
- **Authorized official phone:** (440) 354-1642

## Contact information

- **Practice address:** 36100 EUCLID AVE, SUITE 400, WILLOUGHBY, OH 44094-4456
- **Practice address phone:** (440) 602-6735
- **Practice address fax:** (440) 946-3221
- **Mailing address:** PO BOX 714328, COLUMBUS, OH 43271-4328
- **Mailing address phone:** (440) 602-6735
- **Mailing address fax:** (440) 946-3221

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RC0001X | Clinical Cardiac Electrophysiology Physician | — | NULL | Yes |
| 207RC0001X | Clinical Cardiac Electrophysiology Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/23/2010
- **Last updated:** 09/23/2010