Organization
LAKE HOSPITAL SYSTEM, INC.
Active
Other names
PrimeHealth Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT TRACZ (CHIEF FINANCIAL OFFICER)
(440) 354-1642
Entity
Organization
Contact information
Practice address
29804 LAKESHORE BLVD, WILLOWICK, OH 44095-4611
(440) 354-1899
(440) 354-1089
Mailing address
PO BOX 714328, COLUMBUS, OH 43271-4328
(800) 354-1985
(440) 350-4938
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
01/07/2009
Last updated
01/07/2009
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