Provider Demographics
NPI:1871652461
Name:AURORA MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:AURORA MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-299-1623
Mailing Address - Street 1:525 KENOSHA ST
Mailing Address - Street 2:STE A
Mailing Address - City:WALWORTH
Mailing Address - State:WI
Mailing Address - Zip Code:53184-9512
Mailing Address - Country:US
Mailing Address - Phone:262-275-2101
Mailing Address - Fax:
Practice Address - Street 1:525 KENOSHA ST
Practice Address - Street 2:STE A
Practice Address - City:WALWORTH
Practice Address - State:WI
Practice Address - Zip Code:53184-9512
Practice Address - Country:US
Practice Address - Phone:262-275-2101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0377550052Medicare NSC