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804 E Front St Buchanan MI 49107-1444 | |
(269) 695-3897 | |
(269) 695-6407 |
Full Name | |
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Speciality | Family Medicine |
Location | 804 E Front St, Buchanan, Michigan |
Authorized Official Name and Position | Jeffrey P. Costello (CFO) |
Authorized Official Contact | 5746473549 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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710 N Niles Ave South Bend IN 46617-1924 Ph: (574) 647-1610 | 804 E Front St Buchanan MI 49107-1444 Ph: (269) 695-3897 |
NPI Number | 1487036869 |
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Provider Enumeration Date | 06/23/2015 |
Last Update Date | 09/20/2016 |
Identifier | Type | State | Issuer |
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1487036869 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |