Organization
LAKE HOSPITAL SYSTEM, INC.
Active
Other names
Lake Health Physician Group Plastic Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT B TRACZ (CHIEF FINANCIAL OFFICER)
(440) 354-1642
Entity
Organization
Contact information
Practice address
9500 MENTOR AVE, SUITE 200, MENTOR, OH 44060-8713
(440) 205-5433
(440) 205-5451
Mailing address
PO BOX 714328, COLUMBUS, OH 43271-4328
(440) 205-5433
(440) 205-5451
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Enumeration date
06/17/2010
Last updated
06/17/2010
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