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Organization
BEACON MEDICAL GROUP MICHIGAN INC
Active
Organization
BEACON MEDICAL GROUP MICHIGAN INC
Active
Other names
Beacon Medical Group Michigan
Organization subpart
No
Provider details
NPI number
Authorized official
IRENE MAFFETONE (MANAGER CONTRACTING AND PAYOR RELAT)
(574) 647-1040
Entity
Organization
Contact information
Practice address
7775 ANGLING RD, PORTAGE, MI 49024-7427
(269) 324-8670
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-1820
(574) 647-1821
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
NULL
363L00000X
Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
NULL
363LP2300X
Primary Care Nurse Practitioner
—
NULL
Other
Enumeration date
03/07/2007
Last updated
10/15/2026
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