OrganizationActive
Beacon Medical Group, Inc.
NPI 1487038360 · Vascular & Interventional Radiology Physician · Granger, IN
Provider details
- NPI number
- 1487038360
- Entity type
- Organization
- Primary specialty
- Vascular & Interventional Radiology PhysicianAllopathic & Osteopathic Physicians
- Parent organization
- Beacon Health System, Inc.
- Authorized official
- Jeffrey Costello, Cfo
Practice location
233 Florence Ave
Granger, IN 46530-8048
Phone: (574) 647-3990
Fax: (574) 647-3995
Mailing address
710 E Niles Ave
South Bend, IN 46617-1924
Registry dates
- Enumerated
- 2015-07-10
- Last updated
- 2017-10-12
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.