Healthcare Provider Details

I. General information

NPI: 1619901832
Provider Name (Legal Business Name): AURORA HEALTH CARE METRO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 N 12TH ST
MILWAUKEE WI
53233-1308
US

IV. Provider business mailing address

PO BOX 208
SHEBOYGAN WI
53082-0208
US

V. Phone/Fax

Practice location:
  • Phone: 414-219-7963
  • Fax: 414-219-7964
Mailing address:
  • Phone: 920-803-3263
  • Fax: 920-459-2634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number8900
License Number StateWI

VIII. Authorized Official

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