Organization
BEACON MEDICAL GROUP, INC.
Active
Organization
BEACON MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY P COSTELLO (CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
1506 OSOLO RD STE C, ELKHART, IN 46514-4122
(574) 266-6050
(574) 262-8485
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 266-6050
(574) 262-8485
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201120750B
—
IN
Enumeration date
12/04/2012
Last updated
04/24/2023
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