GRAND LAKE PODIATRY, INC is a foot and ankle surgery podiatrist in Minster, OH. GRAND LAKE PODIATRY, INC NPI is 1164694428. The provider is registered as an organization entity type and is a single specialty group.
The provider's business location address is:
6 EAGLE DR
MINSTER, OH
ZIP 45865-714
Phone: (419) 628-7874
Fax: (419) 628-4620
The provider's authorized official is Mary Katherine Benjamin-swonger .
The authorized official title is Podiatrist/owner-president and has the following contact phone number (419) 586-7874.
The CLIA number assigned to this NPI record is 36D2154011 - physician office with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 3/27/2008 and was last updated on 4/18/2008.