Provider Demographics
NPI:1841797198
Name:WRIGHT, KIWAN L (DO)
Entity type:Individual
Prefix:DR
First Name:KIWAN
Middle Name:L
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:847-390-4757
Practice Address - Street 1:695 PARK AVE
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-6531
Practice Address - Country:US
Practice Address - Phone:224-541-9100
Practice Address - Fax:224-541-9070
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.169678207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine