| Beacon Medical Group Mishawaka | |
|
5314 Lincolnway E Mishawaka IN 46544-4249 | |
| (574) 584-2812 | |
| (574) 584-2813 |
| Full Name | Beacon Medical Group Mishawaka |
|---|---|
| Speciality | Family Medicine |
| Location | 5314 Lincolnway E, Mishawaka, Indiana |
| 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 |
|---|---|
| Beacon Medical Group Mishawaka 3245 Health Dr Ste 100 Granger IN 46530-1380 Ph: (574) 647-2129 | Beacon Medical Group Mishawaka 5314 Lincolnway E Mishawaka IN 46544-4249 Ph: (574) 584-2812 |
| NPI Number | 1275550899 |
|---|---|
| Provider Enumeration Date | 07/17/2006 |
| Last Update Date | 03/04/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275550899 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
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