Organization
AURORA HEALTH CARE SOUTHERN LAKES, INC.
Active
Other names
Aurora Medical Center Kenosha
Organization subpart
No
Provider details
NPI number
Authorized official
KARA RICHARDSON (VP MANAGED HEEALTH)
(704) 631-0450
Entity
Organization
Contact information
Practice address
10400 75TH ST, KENOSHA, WI 53142
(262) 942-5600
Mailing address
10400 75TH ST, KENOSHA, WI 53142-7884
(262) 942-5600
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
—
207U00000X
Nuclear Medicine Physician
—
—
2085R0001X
Radiation Oncology Physician
—
—
208600000X
Surgery Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
261QR0208X
Mobile Radiology Clinic/Center
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
282N00000X
General Acute Care Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11022500
—
WI
05
—
41224100
—
WI
05
—
41565500
—
WI
05
—
41759000
—
WI
Enumeration date
03/26/2007
Last updated
10/01/2025
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