Provider Demographics
NPI:1235646191
Name:LAKE POINT MEDICAL GROUP,LLC
Entity Type:Organization
Organization Name:LAKE POINT MEDICAL GROUP,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KHURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-226-8700
Mailing Address - Street 1:15800 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3748
Mailing Address - Country:US
Mailing Address - Phone:216-226-8700
Mailing Address - Fax:216-221-3171
Practice Address - Street 1:15800 DETROIT AVE STE 2A
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3748
Practice Address - Country:US
Practice Address - Phone:216-226-8700
Practice Address - Fax:216-221-3171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-01
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty