# GRAND LAKE PODIATRY INC

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

## Provider details

- **NPI number:** 1871765362
- **Authorized official:** DR. MARY KATHERINE SWONGER DPM (PODIATRIST/OWNER-PRESIDENT)
- **Authorized official phone:** 41958687874

## Contact information

- **Practice address:** 1222 IRMSCHER BLVD, CELINA, OH 45822-8305
- **Practice address phone:** (419) 586-7874
- **Practice address fax:** (419) 586-2776
- **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:** 03/25/2008
- **Last updated:** 06/14/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2056313 | — | OH |