Healthcare Provider Details

I. General information

NPI: 1437170206
Provider Name (Legal Business Name): AURORA HEALTH CARE VENTURES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SERVICE RD
KIEL WI
53042-1295
US

IV. Provider business mailing address

1001 SERVICE RD
KIEL WI
53042-1295
US

V. Phone/Fax

Practice location:
  • Phone: 920-894-1025
  • Fax: 920-894-1026
Mailing address:
  • Phone: 920-894-1025
  • Fax: 920-894-1026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MARY PANTEL
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 920-803-3266