Healthcare Provider Details

I. General information

NPI: 1164059622
Provider Name (Legal Business Name): MARK THORUP WRIGHT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 10/26/2024
Certification Date: 10/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 WATERTOWN PLANK RD
MILWAUKEE WI
53226-3548
US

IV. Provider business mailing address

42ND AND EMILE ST
OMAHA NE
68198-0001
US

V. Phone/Fax

Practice location:
  • Phone: 414-777-7700
  • Fax:
Mailing address:
  • Phone: 402-559-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number8154721
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: