Provider Demographics
NPI:1679592885
Name:LAKE ORTHOPAEDIC ASSOCIATES, INC.
Entity Type:Organization
Organization Name:LAKE ORTHOPAEDIC ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:E
Authorized Official - Last Name:NAHRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-942-1050
Mailing Address - Street 1:36060 EUCLID AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4656
Mailing Address - Country:US
Mailing Address - Phone:440-942-1050
Mailing Address - Fax:440-942-9433
Practice Address - Street 1:36060 EUCLID AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4656
Practice Address - Country:US
Practice Address - Phone:440-942-1050
Practice Address - Fax:440-942-9433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0977591Medicaid
OHDE9928641Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER #