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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
140 FOX RD, STE104, VAN WERT, OH 45891-2475
(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
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
36 002772
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2544894
OH
Enumeration date
03/31/2008
Last updated
02/01/2011
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