Provider Demographics
NPI:1437296761
Name:WRIGHT, DEBRA JANE (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JANE
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 1:22151 MOROSS RD
Mailing Address - Street 2:STE 313
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2167
Mailing Address - Country:US
Mailing Address - Phone:313-343-3494
Mailing Address - Fax:313-343-4932
Practice Address - Street 1:22151 MOROSS RD
Practice Address - Street 2:STE 313
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2167
Practice Address - Country:US
Practice Address - Phone:313-343-3494
Practice Address - Fax:313-343-4932
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045209207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4967230Medicaid
MI4967221Medicaid
MI5214260Medicaid
MI4967230Medicaid
ON71840Medicare ID - Type Unspecified
MI5214260Medicaid