GRAND LAKE PODIATRY INC NPI 1538331525

NPI Information

GRAND LAKE PODIATRY, INC is a foot and ankle surgery podiatrist in Wapakoneta, OH. GRAND LAKE PODIATRY, INC NPI is 1538331525. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

812 REDSKIN TRL
STE B
WAPAKONETA, OH
ZIP 45895-545
Phone: (419) 586-7874
Fax: (419) 586-2776

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 enumeration date for this NPI number is 3/31/2008 and was last updated on 4/18/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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