Healthcare Provider Details

I. General information

NPI: 1235069857
Provider Name (Legal Business Name): FAMILY FIRST MEDICAL CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6322 N CICERO AVE
CHICAGO IL
60646-4422
US

IV. Provider business mailing address

833 OTTAWA AVE
PARK RIDGE IL
60068-2757
US

V. Phone/Fax

Practice location:
  • Phone: 773-736-8088
  • Fax:
Mailing address:
  • Phone: 847-962-3567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARMAINE M HENNES
Title or Position: OWNER
Credential: MD
Phone: 847-962-3567