Organization
LAKE OBSTETRICS AND GYNECOLOGY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSANNA BOWMAN (OFFICE MANAGER)
(440) 357-7100
Entity
Organization
Contact information
Practice address
8300 TYLER BLVD STE 300, MENTOR, OH 44060-4251
(440) 557-7100
Mailing address
8300 TYLER BLVD STE 300, MENTOR, OH 44060-4251
(440) 357-7100
(440) 357-8136
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0890175
—
OH
Enumeration date
04/06/2006
Last updated
08/07/2025
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