Provider Demographics
NPI:1215446331
Name:WIGHT, CHASE BENNETT (PA-C)
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:BENNETT
Last Name:WIGHT
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DRIVE
Mailing Address - Street 2:SUITE J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:850-877-8174
Mailing Address - Fax:850-877-5636
Practice Address - Street 1:TRINITY HEALTH IHA MEDICAL GROUP NEUROLOGY
Practice Address - Street 2:5333 MCAULEY DRIVE STE 6109
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1005
Practice Address - Country:US
Practice Address - Phone:734-712-1400
Practice Address - Fax:734-623-2857
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2023-11-08
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Provider Licenses
StateLicense IDTaxonomies
FLPA9110674363A00000X
MI5601011839363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant