Organization
COLUMBUS SOUTHERN MEDICAL GROUP LLC
Active
Other names
dr gursal LLC
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN LAKE DO (DOCTOR)
(614) 748-2000
Entity
Organization
Contact information
Practice address
2912 S HIGH STREET, COLUMBUS, OH 43207
(614) 748-2000
(614) 748-3000
Mailing address
2912 S HIGH STREET, COLUMBUS, OH 43207
(614) 748-2000
(614) 748-3000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OH34005855L
OH
Other
Enumeration date
06/25/2006
Last updated
08/22/2020
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