Grand Lake Podiatry Inc

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

36 002772 Issued in OH

Legal business name

GRAND LAKE PODIATRY INC

Practice address

3772 US RT 68 S
Bellefontaine, OH 43311-3311

Phone

(937) 599-3668

Fax

(937) 599-4852

NPI assigned

Mar 27, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mary Katherine Benjamin-Swonger, DPM

Title

Podiatrist/Owner-President

Phone

(419) 586-7874

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307577600000",
    "number": "1184896383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1222 IRMSCHER BLVD",
            "city": "CELINA",
            "state": "OH",
            "postal_code": "458228305",
            "telephone_number": "419-586-7874",
            "fax_number": "419-586-2776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3772 US RT 68 S",
            "city": "BELLEFONTAINE",
            "state": "OH",
            "postal_code": "433113311",
            "telephone_number": "937-599-3668",
            "fax_number": "937-599-4852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND LAKE PODIATRY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-27",
        "last_updated": "2011-06-09",
        "status": "A",
        "authorized_official_last_name": "BENJAMIN-SWONGER",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "KATHERINE",
        "authorized_official_title_or_position": "PODIATRIST/OWNER-PRESIDENT",
        "authorized_official_telephone_number": "419-586-7874",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "OH",
            "license": "36 002772",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2544858",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Goble, D.D.S.
• Stephanie Godwin
• Anita Goldsmith
• Lisa Ayn Gonzales, MIDWIFE
• Chelsea Graham, APRN-CNP
• Elijah Walker Green, DC
• Norman Xavier Greene, M.D.
• Christine Orlowski Greenwald, LPCC
• Michelle Marie Grider, PA-C
• Todd Griffey, RPH

• Foot & Ankle Surgery Podiatrist in Bellefontaine, OH
• Providers in Bellefontaine, OH by specialty
• Foot & Ankle Surgery Podiatrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.