Provider Demographics
NPI:1083784227
Name:WRIGHT, KIMBERLY E (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:E
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 1:3033 OGDEN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1673
Mailing Address - Country:US
Mailing Address - Phone:630-717-5700
Mailing Address - Fax:630-717-0665
Practice Address - Street 1:3033 OGDEN AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1673
Practice Address - Country:US
Practice Address - Phone:630-717-5700
Practice Address - Fax:630-717-0665
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-107680207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107680Medicaid
ILH76493Medicare UPIN
IL204036Medicare ID - Type Unspecified