Healthcare Provider Details

I. General information

NPI: 1316201056
Provider Name (Legal Business Name): ANTHONY JOSEPH WRIGHT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36555 26 MILE RD STE 1100
LENOX MI
48048-3186
US

IV. Provider business mailing address

26901 BEAUMONT BLVD STE 3D
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 947-523-4010
  • Fax:
Mailing address:
  • Phone: 947-522-1848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601006386
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: