| NPI | 1306863915 |
|---|---|
| Doing Business As | BEACON MEDICAL GROUP GOSHEN |
| Entity Type | Organization |
| Authorized Contact | JEFFREY P COSTELLO CFO 574-647-3549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 06-005017-1) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IN 06-005017-1) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2023-04-24 |