| NPI | 1639129117 |
|---|---|
| Doing Business As | BEACON MEDICAL GROUP LAPORTE |
| Entity Type | Organization |
| Authorized Contact | JEFFREY COSTELLO VP CFO 574-647-3549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01056419A) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2024-03-04 |