Organization
LAKE HOSPITAL SYSTEM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL KITTOE (CFO)
(440) 354-1952
Entity
Organization
Contact information
Practice address
36000 EUCLID AVE, WILLOUGHBY, OH 44094-4625
(440) 354-1618
(440) 354-1848
Mailing address
PO BOX 714110, COLUMBUS, OH 43271-4110
(440) 274-5035
(440) 716-8608
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
2080N0001X
Neonatal-Perinatal Medicine Physician
—
—
282N00000X
General Acute Care Hospital
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18300
QUALCHOICE
OH
01
—
5000142
UNITED HEALTHCARE
OH
Enumeration date
04/04/2006
Last updated
08/10/2012
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