Organization
BEACON MEDICAL GROUP, INC.
Active
Other names
Beacon Medical Group Sleep Medicine Elkhart East, Beacon Medical Group Sleep Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY P COSTELLO (CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
525 W BRISTOL ST, ELKHART, IN 46514-2964
(574) 262-0239
(574) 262-8391
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
Taxonomy
Speciality
Code
Description
License number
State
207RS0012X
Sleep Medicine (Internal Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200977370
—
IN
Enumeration date
01/26/2010
Last updated
05/05/2023
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