| NPI | 1861816761 |
|---|---|
| Doing Business As | BEACON MEDICAL GROUP PEDIATRICS BRISTOL STREET |
| Doing Business As | BEACON MEDICAL GROUP PEDIATRICS RIETH BLVD |
| Entity Type | Organization |
| Authorized Contact | JEFFREY P. COSTELLO CFO 574-647-3549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Enumeration Date | 2014-02-12 |
| Last Update Date | 2023-04-28 |