Organization
BEACON MEDICAL GROUP INC
Active
Other names
Michiana Arthritis & Osteoporosis Center
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY COSTELLO (VP-CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
707 N MICHIGAN ST, SUITE 102, SOUTH BEND, IN 46601-1067
(574) 647-4500
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
01061323A
IN
Other
Enumeration date
05/16/2006
Last updated
05/13/2016
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