Organization
LAKE ORTHOPAEDIC ASSOCIATES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAUREEN T PELLETIER (MANAGER)
(440) 352-1711
Entity
Organization
Contact information
Practice address
9500 MENTOR AVE, SUITE 210, MENTOR, OH 44060-8713
(440) 352-1711
(440) 352-7562
Mailing address
9500 MENTOR AVE, SUITE 210, MENTOR, OH 44060-8713
(440) 352-1711
(440) 352-7562
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0975066
—
OH
Enumeration date
07/01/2006
Last updated
06/16/2021
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