Organization
LAKE HOSPITAL SYSTEM, INC.
Active
Other names
Lake Health Physician Group Vascular Access Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD D CICERO (SR. VP, BUSINESS DEVELOPMENT)
(440) 354-1739
Entity
Organization
Contact information
Practice address
36001 EUCLID AVE, B-3, WILLOUGHBY, OH 44094-4643
(440) 953-1898
(440) 953-9296
Mailing address
PO BOX 714328, COLUMBUS, OH 43271-4328
(440) 354-1899
(440) 354-1089
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Enumeration date
06/16/2009
Last updated
04/25/2011
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