Provider Demographics
NPI:1417171018
Name:AURORA MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:AURORA MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BAILET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-389-2377
Mailing Address - Street 1:N168W20060 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WI
Mailing Address - Zip Code:53037-9382
Mailing Address - Country:US
Mailing Address - Phone:262-677-3661
Mailing Address - Fax:
Practice Address - Street 1:N168W20060 MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WI
Practice Address - Zip Code:53037-9382
Practice Address - Country:US
Practice Address - Phone:262-677-3661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty