MEDICARE: LAKE HOSPITAL SYSTEM INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner

General Provider Information

NPI Number	:	1043275837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE HOSPITAL SYSTEM INC.

Provider Business Mailing Address
First Line	:	PO BOX 781348
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48278
Country	:	US
Telephone Number	:	800-354-1985
Fax Number	:	440-354-4938

Provider Business Practice Location Address
First Line	:	7590 AUBURN RD
Second Line	:
City	:	CONCORD TWP
State	:	OH
Zip	:	44077-9176
Country	:	US
Telephone Number	:	440-375-8152
Fax Number	:	440-354-1245

Authorized Official
Title or Position	:	CFO
Name	:	MR. ROBERT TRACZ
Credential	:
Telephone Number	:	440-354-1051

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	07/21/2022

Similar Medicare Providers

1356347876 — GUNDUMALLA S GOUD M.D.
Practice Location Address:

7500 AUBURN RD # 2300
CONCORD TWP, OH
44077-9176

Practice Phone: 440-350-7444
Practice Fax: 440-350-7440

1548229552 — DRS HILL AND CHAPNICK INC
Practice Location Address:

7590 AUBURN RD
CONCORD TWP, OH
44077-9176

Practice Phone: 440-354-4208
Practice Fax:

1659330025 — DR. MILAGRES MARTIN FERNANDES MD
Practice Location Address:

7500 AUBURN RD # 2300
CONCORD TWP, OH
44077-9176

Practice Phone: 440-358-5555
Practice Fax: 440-358-5556

1346496163 — MARK WARREN NELSON D.O.
Practice Location Address:

7590 AUBURN RD
CONCORD TWP, OH
44077-9176

Practice Phone: 440-354-4208
Practice Fax: 440-354-1151

1528295466 — UNIVERSITY PRIMARY CARE PRACTICES INC
Practice Location Address:

7500 AUBURN RD # 1200
CONCORD TWP, OH
44077-9176

Practice Phone: 440-358-5400
Practice Fax: 440-358-5401

1255561742 — UNIVERSITY PRIMARY CARE PRACTICES INC
Practice Location Address:

7500 AUBURN RD # 2300
CONCORD TWP, OH
44077-9176

Practice Phone: 440-358-5555
Practice Fax: 440-358-5556

Directions to “LAKE HOSPITAL SYSTEM INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.