Organization
GRAND LAKE PODIATRY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY KATHERINE BENJAMIN-SWONGER DPM (PODIATRIST/OWNER-PRESIDENT)
(419) 586-7874
Entity
Organization
Contact information
Practice address
3772 US RT 68 S, BELLEFONTAINE, OH 43311-3311
(937) 599-3668
(937) 599-4852
Mailing address
1222 IRMSCHER BLVD, CELINA, OH 45822-8305
(419) 586-7874
(419) 586-2776
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
36 002772
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2544858
—
OH
Enumeration date
03/27/2008
Last updated
06/09/2011
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