Provider Demographics
NPI:1528193174
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:MD
Authorized Official - Phone:414-647-3047
Mailing Address - Street 1:215 S WALES
Mailing Address - Street 2:
Mailing Address - City:HUSTISFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53034
Mailing Address - Country:US
Mailing Address - Phone:920-349-3255
Mailing Address - Fax:
Practice Address - Street 1:215 S WALES
Practice Address - Street 2:
Practice Address - City:HUSTISFORD
Practice Address - State:WI
Practice Address - Zip Code:53034
Practice Address - Country:US
Practice Address - Phone:920-349-3255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0377550044Medicare NSC