Healthcare Provider Details

I. General information

NPI: 1518135383
Provider Name (Legal Business Name): AURORA MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 12/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 FOND DU LAC AVE
KEWASKUM WI
53040-9583
US

IV. Provider business mailing address

1020 FOND DU LAC AVE
KEWASKUM WI
53040-9583
US

V. Phone/Fax

Practice location:
  • Phone: 262-626-2372
  • Fax:
Mailing address:
  • Phone: 262-626-2372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY W BAILET
Title or Position: PRESIDENT
Credential: MD
Phone: 414-647-6322