Healthcare Provider Details

I. General information

NPI: 1124056643
Provider Name (Legal Business Name): TERRENCE PATRICK WRIGHT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 3 MILE RD NW SUITE 200
GRAND RAPIDS MI
49544-8229
US

IV. Provider business mailing address

721 3 MILE RD NW SUITE 200
GRAND RAPIDS MI
49544-8229
US

V. Phone/Fax

Practice location:
  • Phone: 616-647-3770
  • Fax: 616-647-3776
Mailing address:
  • Phone: 616-647-3770
  • Fax: 616-647-3776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTW050181
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: