Provider Demographics
NPI:1285713842
Name:LAKE HEALTH-UNIVERSITY HOSPITALS SEIDMAN CANCER CENTER
Entity type:Organization
Organization Name:LAKE HEALTH-UNIVERSITY HOSPITALS SEIDMAN CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-205-5759
Mailing Address - Street 1:9485 MENTOR AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4597
Mailing Address - Country:US
Mailing Address - Phone:440-205-5759
Mailing Address - Fax:440-205-5790
Practice Address - Street 1:9485 MENTOR AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4597
Practice Address - Country:US
Practice Address - Phone:440-205-5759
Practice Address - Fax:440-205-5790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2103315Medicaid
OH2103315Medicaid