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Organization
LAKE HOSPITAL SYSTEM INC.
Active
Organization
LAKE HOSPITAL SYSTEM INC.
Active
Other names
Lake Health Urgent Care and Walk In Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BOB TRACZ (CFO)
(440) 354-1953
Entity
Organization
Contact information
Practice address
29804 LAKE SHORE BLVD, WILLOWICK, OH 44095-4611
(440) 585-3322
(440) 585-1962
Mailing address
PO BOX 781348, DETROIT, MI 48278-1348
(800) 354-1895
(440) 585-1962
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
208D00000X
General Practice Physician
—
NULL
208D00000X
General Practice Physician
—
—
261QU0200X
Urgent Care Clinic/Center
Primary
—
NULL
Other
Enumeration date
03/23/2006
Last updated
02/15/2017
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