Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Lake Hospital System, Inc

Organization Sports Medicine (Family Medicine) Physician · NPI 1639315062

Lake Hospital System, Inc is a Sports Medicine (Family Medicine) Physician in Willowick, Ohio. Registered with an NPI since 2009.

In the registry since
2009
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

29804 Lakeshore Blvd
Willowick, OH 44095-4611
Phone: (440) 354-1899
Fax: (440) 354-1089
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Sports Medicine (Family Medicine) Physician (primary) Taxonomy 207QS0010X

Record details

NPI number1639315062
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Robert Tracz — Chief Financial Officer · (440) 354-1642
Other names Primehealth Sports Medicine
NPI enumeratedJanuary 7, 2009
Last updated in NPPESJanuary 7, 2009
Mailing addressPo Box 714328, Columbus, OH 43271-4328

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