Organization
GRAND LAKE FOOT & ANKLE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY BENJAMIN SWONGER DPM (DPM)
(419) 586-7874
Entity
Organization
Contact information
Practice address
1222 IRMSCHER BLVD, CELINA, OH 45822-8305
(419) 586-7874
(419) 586-2776
Mailing address
1222 IRMSCHER BLVD, CELINA, OH 45822-8305
(419) 586-7874
(419) 586-2776
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
36002772
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0061420
—
OH
Enumeration date
11/02/2011
Last updated
03/22/2016
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