Healthcare Provider Details

I. General information

NPI: 1740484732
Provider Name (Legal Business Name): AURORA MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 E SUMMIT AVE SUITE 100
WALES WI
53183-9546
US

IV. Provider business mailing address

144 E SUMMIT AVE SUITE 100
WALES WI
53183-9546
US

V. Phone/Fax

Practice location:
  • Phone: 262-968-6160
  • Fax:
Mailing address:
  • Phone: 262-968-6160
  • 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 BALIET
Title or Position: PRESIDENT
Credential:
Phone: 414-647-6322