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NPI 1992756696

OrganizationActive

Beacon Medical Group, Inc.

NPI 1992756696 · Pediatric Hematology & Oncology Physician · South Bend, IN

Provider details

NPI number: 1992756696
Entity type: Organization
Primary specialty: Pediatric Hematology & Oncology PhysicianAllopathic & Osteopathic Physicians
Organization subpart: No
Authorized official: Jeffrey Costello, Cfo(574) 647-3549
License: 02001713A (IN)

Specialties & taxonomies

Pediatric Hematology & Oncology PhysicianPrimary2080P0207XLicense 02001713A (IN)
Allopathic & Osteopathic Physicians

Practice location

615 N Michigan St 4th Fl

South Bend, IN 46601-1033

Phone: (574) 647-6892

Fax: (574) 647-6895

Approximate (ZIP-level) locationGet directions

More IN providers

Mailing address

710 N Niles Ave

South Bend, IN 46617-1924

Other names (DBA / former)

Doing business as: Beacon Medical Group Pediatric Hematology Oncology

Registry dates

Enumerated: 2006-05-15
Last updated: 2024-03-04
Certified: 2024-03-04

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.

Beacon Medical Group, Inc. — NPI 1992756696, South Bend, IN | NPI Central