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General NPI Number Information
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NPI Number | 1760331037
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Entity Type | Organization
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Legal Business Name | BEACON HEALTH VENTURES INC
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Dates
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Enumeration Date | 01/28/2026
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 12785 EMERSON DR
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City | BRIGHTON
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State | MI
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Zip | 48116-8562
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Country | US
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Telephone | 248-486-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 12785 EMERSON DR
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City | BRIGHTON
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State | MI
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Zip | 48116-8562
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Country | US
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Telephone | 248-486-3800
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JEFFREY COSTELLO
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Credential |
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Telephone | 574-647-3460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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