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Organization
BEACON MEDICAL GROUP, INC.
Active
Organization
BEACON MEDICAL GROUP, INC.
Active
Other names
Beacon Medical Group Specialists Bremen
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY P. COSTELLO (VP/CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
1020 HIGH RD, BREMEN, IN 46506-1093
(574) 546-8044
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
07001058A
IN
Other
Enumeration date
04/27/2011
Last updated
08/30/2016
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