# LAKE HOSPITAL SYSTEM INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lake Health Urgent Care and Walk In Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912967209
- **Authorized official:** MR. BOB TRACZ (CFO)
- **Authorized official phone:** (440) 354-1953

## Contact information

- **Practice address:** 29804 LAKE SHORE BLVD, WILLOWICK, OH 44095-4611
- **Practice address phone:** (440) 585-3322
- **Practice address fax:** (440) 585-1962
- **Mailing address:** PO BOX 781348, DETROIT, MI 48278-1348
- **Mailing address phone:** (800) 354-1895
- **Mailing address fax:** (440) 585-1962

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |

## Other

- **Enumeration date:** 03/23/2006
- **Last updated:** 02/15/2017