Grand Lake Podiatry, INC
NPI #1538331525 in Wapakoneta, Ohio
Provider Information
- NPI Number
- 1538331525
- Entity Type
- Organization
- Organization Name
- Grand Lake Podiatry, INC
- Primary Specialty
- Podiatrist - Foot & Ankle Surgery
- Enumeration Date
- Mar 31, 2008
- Last Updated
- Apr 18, 2008
Practice Location
- Address
- 812 REDSKIN TRL
- Address 2
- STE B
- City
- Wapakoneta
- State
- Ohio
- ZIP Code
- 45895-8545
- Phone
- (419) 586-7874
Authorized Official
- Name
- DR. MARY KATHERINE BENJAMIN-SWONGER, DPM
- Title
- PODIATRIST/OWNER-PRESIDENT
- Phone
- (419) 586-7874
Specialties & Taxonomy Codes
| Specialty |
|---|
| Podiatrist - Foot & Ankle Surgery — Foot & Ankle Surgery |
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