MEDICARE: AURORA MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1417002080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AURORA MEDICAL GROUP

Provider Business Mailing Address
First Line	:	1565 ALLOUEZ AVE
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-5639
Country	:	US
Telephone Number	:	920-468-2400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1565 ALLOUEZ AVE
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-5639
Country	:	US
Telephone Number	:	920-468-2400
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEFFREY W BAILET
Credential	:	MD
Telephone Number	:	414-647-3047

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	02/15/2008

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