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1124423546
BEACON MEDICAL GROUP, INC.
SOUTH BEND, IN
NPI
1124423546
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Entity Type
Organization
Authorized Contact
JEFFREY P. COSTELLO
CFO
574-647-3549
Organization Subpart ?
No
Primary Taxonomy
207RN0300X Internal Medicine, Nephrology
Enumeration Date
2014-10-28
Last Update Date
2017-10-12
Business Address
BEACON MEDICAL GROUP, INC.
100 NAVARRE PL STE 4400
SOUTH BEND, IN 46601-1100
Phone number: 574-647-1972
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Mailing Address
BEACON MEDICAL GROUP, INC.
710 N NILES AVE
SOUTH BEND, IN 46617-1924
Phone number: 574-647-1610
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