# LAKE OBSTETRICS AND GYNECOLOGY, INC

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

## Provider details

- **NPI number:** 1811950447
- **Authorized official:** SUSANNA BOWMAN (OFFICE MANAGER)
- **Authorized official phone:** (440) 357-7100

## Contact information

- **Practice address:** 8300 TYLER BLVD STE 300, MENTOR, OH 44060-4251
- **Practice address phone:** (440) 557-7100
- **Mailing address:** 8300 TYLER BLVD STE 300, MENTOR, OH 44060-4251
- **Mailing address phone:** (440) 357-7100
- **Mailing address fax:** (440) 357-8136

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/06/2006
- **Last updated:** 08/07/2025