Provider Demographics
NPI:1942257258
Name:WRIGHT, ANGELA C (DO)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:CW
Other - Last Name:GRUESEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:111 E WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4815
Mailing Address - Country:US
Mailing Address - Phone:414-290-6720
Mailing Address - Fax:414-290-6755
Practice Address - Street 1:111 E WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-4815
Practice Address - Country:US
Practice Address - Phone:414-290-6720
Practice Address - Fax:414-290-6755
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42941-021207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43491500Medicaid
WI930106719OtherMEDICARE RAILROAD
WI0033-17130Medicare ID - Type Unspecified
WI930106719OtherMEDICARE RAILROAD
WI0045-07660Medicare ID - Type Unspecified