| NPI | 1306899554 |
|---|---|
| Doing Business As | BEACON MEDICAL GROUP SPECIALISTS MAIN SUITE 100 |
| Entity Type | Organization |
| Authorized Contact | JEFFREY COSTELLO VP CFO 574-647-3549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism |
| Additional Taxonomies | 207N00000X Dermatology |
| 207Q00000X Family Medicine | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2019-12-09 |