Healthcare Provider Details

I. General information

NPI: 1184038002
Provider Name (Legal Business Name): AISHA WRIGHT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 W LAKE ST
CHICAGO IL
60644-2342
US

IV. Provider business mailing address

850 5TH AVE E
TUSCALOOSA AL
35401-7419
US

V. Phone/Fax

Practice location:
  • Phone: 773-378-3347
  • Fax: 773-378-4028
Mailing address:
  • Phone: 205-348-1770
  • Fax: 205-348-5294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL4031R
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036143077
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: