Organization
COLUMBUS SOUTHERN MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN LAKE (MEDICAL DIRECTOR)
(614) 497-3400
Entity
Organization
Contact information
Practice address
2912 S HIGH ST, COLUMBUS, OH 43207-3616
(614) 497-3400
Mailing address
2912 S HIGH ST, COLUMBUS, OH 43207-3616
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
01/17/2008
Last updated
01/17/2008
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