Healthcare Provider Details

I. General information

NPI: 1720012941
Provider Name (Legal Business Name): AURORA SINAI MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 W GRANT ST
MILWAUKEE WI
53215-2732
US

IV. Provider business mailing address

1230 W GRANT ST
MILWAUKEE WI
53215-2732
US

V. Phone/Fax

Practice location:
  • Phone: 414-672-5147
  • Fax: 414-384-5578
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number6992
License Number StateWI

VIII. Authorized Official

Name: VICKI SOERENS
Title or Position: BILLING MANAGER
Credential:
Phone: 920-803-3260