| NPI | 1568413359 |
|---|---|
| Doing Business As | BEACON MEDICAL GROUP PORTAGE ROAD |
| Entity Type | Organization |
| Authorized Contact | JEFFREY COSTELLO VP CFO 574-647-3549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01054535A) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2013-09-27 |