Organization
LAKE HOSPITAL SYSTEM, INC.
Active
Other names
Lake Health Physician Group Mentor General 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
9500 MENTOR AVE, SUITE 300, MENTOR, OH 44060-8713
(440) 354-0377
(440) 354-9368
Mailing address
PO BOX 714328, COLUMBUS, OH 43271-4328
(440) 354-0377
(440) 354-9368
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
04/21/2011
Last updated
04/21/2011
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