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27082 W Main Street Edwardsburg MI 49112-9334 | |
| (269) 663-8288 | |
| (269) 663-2426 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 27082 W Main Street, Edwardsburg, Michigan |
| Authorized Official Name and Position | Jeff P Costello (CFO) |
| Authorized Official Contact | 5746473549 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
710 N Niles Ave South Bend IN 46617-1924 Ph: (574) 647-1610 | 27082 W Main Street Edwardsburg MI 49112-9334 Ph: (269) 663-8288 |
| NPI Number | 1205852365 |
|---|---|
| Provider Enumeration Date | 07/14/2006 |
| Last Update Date | 05/03/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205852365 | NPI | - | NPPES |
| 080A410090 | Medicaid | MI | |
| 100220310A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 06-005017-1 (Indiana) | Primary |
Healthy Cocoon Practice Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 27082 W. Main Street, Edwardsburg, MI 49112 Phone: 269-246-1375 Fax: 269-246-1376 | |
Advanced Practice Primary Care Staff Associates Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 27160 Deerfield Ln, Edwardsburg, MI 49112 Phone: 574-485-9541 |