Organization
BEACON MEDICAL GROUP, INC.
Active
Other names
Beacon Medical Group Specialists Bremen
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY P. COSTELLO (VP/CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
1020 HIGH RD, BREMEN, IN 46506-1093
(574) 546-8044
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
07001058A
IN
Other
Enumeration date
04/27/2011
Last updated
08/30/2016
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