Organization
MEMORIAL HEALTH SYSTEM, INC.
Active
Other names
Developmental Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY COSTELLO (VP-CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
809 N MICHIGAN ST, SOUTH BEND, IN 46601-1088
(574) 647-7300
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
01060385A
IN
Other
Enumeration date
05/11/2006
Last updated
03/09/2016
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