Organization
AURORA MEDICAL GROUP INC
Active
Other names
Aurora Medical Group Lake Geneva
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFERY BAILET (PRESIDENT)
(414) 647-6322
Entity
Organization
Contact information
Practice address
146 E GENEVA SQ, LAKE GENEVA, WI 53147-9694
(262) 249-5040
(262) 249-7146
Mailing address
5200 VIRGINIA WAY, 4TH FLOOR L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4521
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
332BD1200X
Dialysis Equipment & Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336296300
—
WI
Enumeration date
01/04/2007
Last updated
09/22/2010
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