Provider Demographics
NPI:1104813849
Name:WRIGHT, KEVIN R (PA)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:630-245-9098
Practice Address - Street 1:120 SPALDING DR STE 400
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6559
Practice Address - Country:US
Practice Address - Phone:630-967-2225
Practice Address - Fax:630-355-3273
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002508363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085002508Medicaid
ILP00297120OtherRAILROAD MEDICARE
ILP00297120OtherRAILROAD MEDICARE
ILQ58722Medicare UPIN
ILK23339Medicare PIN