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 provides Sports Medicine (Family Medicine) Physician services 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 Not confirmed with CMS for 17 years — call before visiting
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

Other providers in Willowick