Provider Demographics
NPI:1972565844
Name:LEMBACH, LAURENCE JOHN (DPM)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:JOHN
Last Name:LEMBACH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13535 DETROIT AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4625
Mailing Address - Country:US
Mailing Address - Phone:216-226-2444
Mailing Address - Fax:216-226-3112
Practice Address - Street 1:13535 DETROIT AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4625
Practice Address - Country:US
Practice Address - Phone:216-226-2444
Practice Address - Fax:216-226-3112
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001762213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP35653478OtherPRINCIPAL MULTI PLAN
OH0310425Medicaid
OH55396OtherQUALCHOICE
OH10196OtherKAISER PERMANENTE
OH2700750OtherUNITED HEALTHCARE
OH791480328OtherRAILROAD MEDICARE
OH000000143072OtherANTHEM BCBS
OH346747145026OtherCARESOURCE
OHL01762OtherSUMMACARE
OH0004297638OtherAETNA
OH0004297638OtherAETNA