# BEACON MEDICAL GROUP, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Beacon Medical Group Schwartz - Wiekamp
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033161617
- **Authorized official:** JEFFREY COSTELLO (VP-CFO)
- **Authorized official phone:** (574) 647-3549

## Contact information

- **Practice address:** 4630 VISTULA RD, MISHAWAKA, IN 46544-4000
- **Practice address phone:** (574) 647-1900
- **Practice address fax:** (574) 254-7222
- **Mailing address:** 3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
- **Mailing address phone:** (574) 647-1840

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 01058339A | IN | Yes |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 207RI0011X | Interventional Cardiology Physician | — | NULL | — |
| 207RI0011X | Interventional Cardiology Physician | — | — | — |

## Other

- **Enumeration date:** 05/16/2006
- **Last updated:** 02/13/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200130710A | — | IN |