Organization
BEACON MEDICAL GROUP INC
Active
Other names
Women's Reproductive Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY COSTELLO (VP-CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
100 NAVARRE PL, SUITE 4470, SOUTH BEND, IN 46601-1156
(574) 647-4230
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01027434A
IN
Other
Enumeration date
05/18/2006
Last updated
08/30/2016
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