Provider Demographics
NPI:1295923001
Name:LAKESHORE HEART, INC.
Entity type:Organization
Organization Name:LAKESHORE HEART, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRAHMBHATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-333-0060
Mailing Address - Street 1:21851 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3976
Mailing Address - Country:US
Mailing Address - Phone:440-333-0060
Mailing Address - Fax:440-333-0065
Practice Address - Street 1:21851 CENTER RIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3976
Practice Address - Country:US
Practice Address - Phone:440-333-0060
Practice Address - Fax:440-333-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH43292207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9252161Medicare UPIN