MEDICARE: DR. MARK LOUIS LEMBACH M.D.

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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	35.127074	OH

General Provider Information

NPI Number	:	1467614990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK LOUIS LEMBACH M.D.

Provider Business Mailing Address
First Line	:	7255 OLD OAK BLVD STE C405
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44130-3331
Country	:	US
Telephone Number	:	440-816-5380
Fax Number	:	440-816-5398

Provider Business Practice Location Address
First Line	:	7255 OLD OAK BLVD STE C405
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44130-3331
Country	:	US
Telephone Number	:	440-816-5380
Fax Number	:	440-816-5398

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	08/06/2014

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