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Organization
BEACON MEDICAL GROUP, INC.
Active
Organization
BEACON MEDICAL GROUP, INC.
Active
Other names
Beacon Medical Group Pediatric Hematology Oncology
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY COSTELLO (CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
615 N MICHIGAN ST 4TH FL, SOUTH BEND, IN 46601-1033
(574) 647-6892
(574) 647-6895
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
02001713A
IN
Other
Enumeration date
05/15/2006
Last updated
03/04/2024
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