| NPI | 1487061131 |
|---|---|
| Doing Business As | BEACON MEDICAL GROUP LAGRANGE SPECIALTY CLINIC |
| Entity Type | Organization |
| Authorized Contact | JEFFREY P COSTELLO CFO 574-647-3549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2016-08-30 |