Provider Demographics
NPI:1386696748
Name:WRIGHT, MARK T (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:T
Last Name:WRIGHT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:912 S WOOD ST # MC913
Mailing Address - Street 2:UIC DEPARTMENT OF PSYCHIATRY
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4300
Mailing Address - Country:US
Mailing Address - Phone:312-996-6139
Mailing Address - Fax:312-413-7856
Practice Address - Street 1:912 S WOOD ST # MC913
Practice Address - Street 2:UIC DEPARTMENT OF PSYCHIATRY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4300
Practice Address - Country:US
Practice Address - Phone:312-996-6139
Practice Address - Fax:312-413-7856
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-11-29
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Provider Licenses
StateLicense IDTaxonomies
IL0361406982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
000017792JOtherHUMANA
WI1386696748Medicaid
WI1386696748Medicaid
WI68086 0680Medicare PIN
000017792JOtherHUMANA