Healthcare Provider Details

I. General information

NPI: 1144660572
Provider Name (Legal Business Name): PETER WRIGLEY M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2013
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W PARK ST
URBANA IL
61801-2529
US

IV. Provider business mailing address

611 W. PARK ST. FAPC
URBANA IL
61801
US

V. Phone/Fax

Practice location:
  • Phone: 217-383-3440
  • Fax:
Mailing address:
  • Phone: 217-902-5291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number270964
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036150593
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number036150593
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: