Provider Demographics
NPI:1497803969
Name:WRIGHT, JIFUNZA CHARLENE (MD)
Entity Type:Individual
Prefix:DR
First Name:JIFUNZA
Middle Name:CHARLENE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11110 S SAWYER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-2724
Mailing Address - Country:US
Mailing Address - Phone:773-881-7191
Mailing Address - Fax:773-239-4259
Practice Address - Street 1:11110 S SAWYER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-2724
Practice Address - Country:US
Practice Address - Phone:773-881-7191
Practice Address - Fax:773-239-4259
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
01621528OtherBLUE CROSS BLUE SHIELD
ILF42215Medicare UPIN
01621528OtherBLUE CROSS BLUE SHIELD