# LAKE HOSPITAL SYSTEM INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LHPG Endocrinology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952339996
- **Authorized official:** MR. ROBERT A TRACZ (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (440) 354-1051

## Contact information

- **Practice address:** 16030 E HIGH ST STE 101, MIDDLEFIELD, OH 44062-9474
- **Practice address phone:** (440) 632-0594
- **Practice address fax:** (440) 632-0596
- **Mailing address:** PO BOX 781389, DETROIT, MI 48278-1389
- **Mailing address phone:** (800) 354-1985
- **Mailing address fax:** (440) 350-4938

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 176B00000X | Midwife | — | NULL | — |
| 176B00000X | Midwife | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RB0002X | Obesity Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RB0002X | Obesity Medicine (Internal Medicine) Physician | — | — | — |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 207RC0001X | Clinical Cardiac Electrophysiology Physician | — | NULL | — |
| 207RC0001X | Clinical Cardiac Electrophysiology Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 06/29/2006
- **Last updated:** 02/02/2022