MEDICARE: LAKE POINT MEDICAL GROUP,LLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1235646191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE POINT MEDICAL GROUP,LLC

Provider Business Mailing Address
First Line	:	15800 DETROIT AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-3748
Country	:	US
Telephone Number	:	216-226-8700
Fax Number	:	216-221-3171

Provider Business Practice Location Address
First Line	:	15800 DETROIT AVE STE 2A
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-3748
Country	:	US
Telephone Number	:	216-226-8700
Fax Number	:	216-221-3171

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. GEORGE M KHURI
Credential	:	MD
Telephone Number	:	216-226-8700

Provider Enumeration Date	:	01/01/2018
Last Update Date	:	03/28/2024

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Directions to “LAKE POINT MEDICAL GROUP,LLC ” Practice Location

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