Healthcare Provider Details

I. General information

NPI: 1144273913
Provider Name (Legal Business Name): AURORA MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4061 OLD PESHTIGO RD
MARINETTE WI
54143-3887
US

IV. Provider business mailing address

3000 W MONTANA ST
MILWAUKEE WI
53215-3628
US

V. Phone/Fax

Practice location:
  • Phone: 715-732-8000
  • Fax:
Mailing address:
  • Phone: 414-647-3047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY W BAILET
Title or Position: PRESIDENT
Credential: MD
Phone: 414-647-3047