Provider Demographics
NPI:1780721332
Name:LAKE ERIE ORTHOPAEDICS LLC
Entity type:Organization
Organization Name:LAKE ERIE ORTHOPAEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KASTRUP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-709-6714
Mailing Address - Street 1:PO BOX 6211
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16512-6211
Mailing Address - Country:US
Mailing Address - Phone:407-709-6714
Mailing Address - Fax:814-454-1476
Practice Address - Street 1:300 STATE ST
Practice Address - Street 2:SUITE 301H
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1430
Practice Address - Country:US
Practice Address - Phone:407-709-6714
Practice Address - Fax:814-454-1476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA034387Medicare ID - Type Unspecified