| Beacon Medical Group, Inc. | |
|
601 North Michigan Street Lakeville IN 46536 | |
| (574) 784-8244 | |
| (574) 784-8632 |
| Full Name | Beacon Medical Group, Inc. |
|---|---|
| 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 |
|---|---|
| Beacon Medical Group, Inc. 710 N Niles Ave South Bend IN 46617-1924 Ph: (574) 647-1610 | Beacon Medical Group, Inc. 601 North Michigan Street Lakeville IN 46536 Ph: (574) 784-8244 |
| NPI Number | 1699727545 |
|---|---|
| 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 |