Provider Demographics
NPI:1013576339
Name:WRIGHT, BLAIR ELISE (MD)
Entity Type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:ELISE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 N MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548-1397
Mailing Address - Country:US
Mailing Address - Phone:815-786-7150
Mailing Address - Fax:815-786-7153
Practice Address - Street 1:1310 N MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-1397
Practice Address - Country:US
Practice Address - Phone:815-786-7150
Practice Address - Fax:815-786-7153
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-11640208000000X
IL036161804208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics