Provider Demographics
NPI:1174665806
Name:HEATHER WRIGHT M.D., P.C.
Entity Type:Organization
Organization Name:HEATHER WRIGHT M.D., P.C.
Other - Org Name:HEATHER WRIGHT M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-694-9421
Mailing Address - Street 1:500 PERRY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1482
Mailing Address - Country:US
Mailing Address - Phone:810-694-9421
Mailing Address - Fax:810-694-9423
Practice Address - Street 1:500 PERRY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1482
Practice Address - Country:US
Practice Address - Phone:810-694-9421
Practice Address - Fax:810-694-9423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065656207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0802512161OtherBLUE CROSS BLUE SHIELD
MIG74770Medicare UPIN