Provider Demographics
NPI:1518385335
Name:WRIGHT, HENRY COLLIER IV
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:COLLIER
Last Name:WRIGHT
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5916
Mailing Address - Country:US
Mailing Address - Phone:847-802-7090
Mailing Address - Fax:847-802-7095
Practice Address - Street 1:1465 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5916
Practice Address - Country:US
Practice Address - Phone:847-802-7090
Practice Address - Fax:847-802-7095
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-29
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.136283208800000X
IL036157614208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology