MEDICARE: LAKE ORTHOPAEDIC ASSOCIATES, 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	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1326366352
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE ORTHOPAEDIC ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	9500 MENTOR AVE
Second Line	:	SUITE 210
City	:	MENTOR
State	:	OH
Zip	:	44060-8713
Country	:	US
Telephone Number	:	440-352-1711
Fax Number	:	440-352-7562

Provider Business Practice Location Address
First Line	:	7580 AUBURN RD
Second Line	:	SUITE 214
City	:	CONCORD TWP
State	:	OH
Zip	:	44077-9615
Country	:	US
Telephone Number	:	440-352-1711
Fax Number	:	440-352-7562

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEVEN COMBS
Credential	:	M.D.
Telephone Number	:	440-352-1711

Provider Enumeration Date	:	05/14/2010
Last Update Date	:	05/14/2010

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