Organization
LAKE COUNTY INTERNAL MEDICINE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HAITHAM J KOUSA MD (OWNER)
(440) 681-0300
Entity
Organization
Contact information
Practice address
9485 MENTOR AVE STE 104, MENTOR, OH 44060-8722
(440) 205-5770
(440) 701-6143
Mailing address
587 CHARLES PL, HIGHLAND HEIGHTS, OH 44143-1949
(440) 681-0300
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
05/17/2023
Last updated
05/17/2023
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