Organization
BEACON MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY P. COSTELLO (CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
100 NAVARRE PL STE 4400, SOUTH BEND, IN 46601-1100
(574) 647-1972
(574) 647-1974
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Enumeration date
10/28/2014
Last updated
10/12/2017
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