| NPI | 1881971505 |
|---|---|
| Doing Business As | BEACON MEDICAL GROUP CARDIOTHORACIC SURGERY SOUTH BEND |
| Entity Type | Organization |
| Authorized Contact | JEFFREY P COSTELLO VP/CFO 574-647-3549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2011-11-09 |
| Last Update Date | 2024-02-22 |