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General NPI Number Information
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NPI Number | 1174670244
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Entity Type | Organization
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Legal Business Name | AURORA MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 08/22/2008
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Provider Practice Location Address
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Address Line | 2414 KOHLER MEMORIAL DR
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City | SHEBOYGAN
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State | WI
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Zip | 53081-3129
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Country | US
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Telephone | 920-457-4461
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Fax |
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Provider Business Mailing Address
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Address Line | 2414 KOHLER MEMORIAL DR
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City | SHEBOYGAN
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State | WI
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Zip | 53081-3129
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Country | US
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Telephone | 920-457-4461
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY W BAILET
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Credential |
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Telephone | 414-647-6322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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