| NPI | 1710939608 |
|---|---|
| Doing Business As | BEACON MEDICAL GROUP MATERNAL FETAL MEDICINE SOUTH BEND |
| Entity Type | Organization |
| Authorized Contact | JEFFREY COSTELLO VP CFO 574-647-3549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207VM0101X Obstetrics & Gynecology, Maternal & Fetal Medicine (Licence: IN 01053966A) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2017-10-12 |