# 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:** 1720009954
- **Authorized official:** IRENE MAFFETONE (MANAGER CONTRACTING AND PAYOR RELAT)
- **Authorized official phone:** (574) 647-1040

## Contact information

- **Practice address:** 1717 SHAFFER ST, STE 124, KALAMAZOO, MI 49048-1647
- **Practice address phone:** (269) 344-5552
- **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 |
| --- | --- | --- | --- | --- |
| 207QH0002X | Hospice and Palliative Medicine (Family Medicine) Physician | — | MI | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 207RG0100X | Gastroenterology Physician | — | NULL | — |
| 207RG0100X | Gastroenterology Physician | — | — | — |
| 207RH0002X | Hospice and Palliative Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RH0002X | Hospice and Palliative Medicine (Internal Medicine) Physician | — | — | — |
| 207RP1001X | Pulmonary Disease Physician | — | NULL | — |
| 207RP1001X | Pulmonary Disease Physician | — | — | — |
| 207RR0500X | Rheumatology Physician | — | NULL | — |
| 207RR0500X | Rheumatology Physician | — | — | — |
| 2080N0001X | Neonatal-Perinatal Medicine Physician | — | NULL | — |
| 2080N0001X | Neonatal-Perinatal Medicine Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 2085N0700X | Neuroradiology Physician | — | NULL | — |
| 2085N0700X | Neuroradiology Physician | — | — | — |
| 2086S0129X | Vascular Surgery Physician | — | NULL | — |
| 2086S0129X | Vascular Surgery Physician | — | — | — |
| 208800000X | Urology Physician | — | NULL | — |
| 208800000X | Urology Physician | — | — | — |
| 363LA2100X | Acute Care Nurse Practitioner | — | NULL | — |
| 363LA2100X | Acute Care Nurse Practitioner | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 07/22/2006
- **Last updated:** 10/09/2026