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
148 N MAIN ST, BLUFFTON, OH 45817-1246
(419) 358-3050
(419) 358-0240
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2057929
—
OH
Enumeration date
08/24/2006
Last updated
04/18/2008
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