Provider Demographics
NPI:1700021268
Name:JIFUNZA CA WRIGHT MD PC
Entity Type:Organization
Organization Name:JIFUNZA CA WRIGHT MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIFUNZA
Authorized Official - Middle Name:CHARLENE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-881-7191
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL2523001Medicare PIN
ILF42215Medicare UPIN