| NPI | 1588024624 |
|---|---|
| Doing Business As | BEACON MEDICAL GROUP CLEVELAND ROAD |
| Entity Type | Organization |
| Authorized Contact | JEFFREY P COSTELLO VP CFO 574-647-3549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207RN0300X Internal Medicine, Nephrology |
| 213ES0103X Podiatrist, Foot & Ankle Surgery | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2016-03-02 |
| Last Update Date | 2024-02-22 |