# BEACON MEDICAL GROUP MICHIGAN INC

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

## Provider details

- **NPI number:** 1538299631
- **Authorized official:** IRENE MAFFETONE (MANAGER CONTRACTING AND PAYOR RELAT)
- **Authorized official phone:** (574) 647-1040

## Contact information

- **Practice address:** 7775 ANGLING RD, PORTAGE, MI 49024-7427
- **Practice address phone:** (269) 324-8670
- **Mailing address:** 3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
- **Mailing address phone:** (574) 647-1820
- **Mailing address fax:** (574) 647-1821

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 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