Beacon Medical Group Lakeville | |
601 North Michigan Street Lakeville IN 46536 | |
(574) 784-8244 | |
(574) 784-8632 |
Full Name | Beacon Medical Group Lakeville |
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Speciality | Family Medicine |
Location | 601 North Michigan Street, Lakeville, Indiana |
Authorized Official Name and Position | Jeffrey Costello (VP-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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Beacon Medical Group Lakeville 710 N Niles Ave South Bend IN 46617-1924 Ph: (574) 647-1610 | Beacon Medical Group Lakeville 601 North Michigan Street Lakeville IN 46536 Ph: (574) 784-8244 |
NPI Number | 1699727545 |
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Provider Enumeration Date | 05/17/2006 |
Last Update Date | 08/29/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1699727545 | NPI | - | NPPES |
200188380A | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 01033081A (Indiana) | Primary |