Provider Demographics
NPI:1235181488
Name:AURORA INTERNAL MEDICINE, LTD.
Entity Type:Organization
Organization Name:AURORA INTERNAL MEDICINE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KULCZYCKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-264-8000
Mailing Address - Street 1:23 S LINCOLNWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-1645
Mailing Address - Country:US
Mailing Address - Phone:630-264-8000
Mailing Address - Fax:630-264-9470
Practice Address - Street 1:23 S LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-1645
Practice Address - Country:US
Practice Address - Phone:630-264-8000
Practice Address - Fax:630-264-9470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086232207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086232Medicaid
IL04521997OtherBLUE CROSS BLUE SHIELD
IL1558311738OtherNPI
IL036086232Medicaid
IL1558311738OtherNPI
IL=========OtherFEIN
IL213698Medicare PIN