# GRAND LAKE PODIATRY INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184896383
- **Authorized official:** DR. MARY KATHERINE BENJAMIN-SWONGER DPM (PODIATRIST/OWNER-PRESIDENT)
- **Authorized official phone:** (419) 586-7874

## Contact information

- **Practice address:** 3772 US RT 68 S, BELLEFONTAINE, OH 43311-3311
- **Practice address phone:** (937) 599-3668
- **Practice address fax:** (937) 599-4852
- **Mailing address:** 1222 IRMSCHER BLVD, CELINA, OH 45822-8305
- **Mailing address phone:** (419) 586-7874
- **Mailing address fax:** (419) 586-2776

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 36 002772 | OH | Yes |

## Other

- **Enumeration date:** 03/27/2008
- **Last updated:** 06/09/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2544858 | — | OH |