Provider Demographics
NPI:1669534673
Name:LAKE ERIE SURGICAL ASSOCIATES INC
Entity type:Organization
Organization Name:LAKE ERIE SURGICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-934-7979
Mailing Address - Street 1:5077 WATERFORD DR
Mailing Address - Street 2:305
Mailing Address - City:SHEFFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44035-0704
Mailing Address - Country:US
Mailing Address - Phone:440-934-7979
Mailing Address - Fax:440-934-6969
Practice Address - Street 1:5077 WATERFORD DR
Practice Address - Street 2:305
Practice Address - City:SHEFFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44035-0704
Practice Address - Country:US
Practice Address - Phone:440-934-7979
Practice Address - Fax:440-934-6969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty