| NPI | 1457378069 |
|---|---|
| Doing Business As | BEACON MEDICAL GROUP WANEE |
| Entity Type | Organization |
| Authorized Contact | JEFFREY P COSTELLO CFO 574-647-3549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2023-04-26 |