Provider Demographics
NPI:1639309917
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 1:1532 UTAH ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-6410
Mailing Address - Country:US
Mailing Address - Phone:920-261-7800
Mailing Address - Fax:
Practice Address - Street 1:1532 UTAH ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-6410
Practice Address - Country:US
Practice Address - Phone:920-261-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0377550128Medicare NSC