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General NPI Number Information
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NPI Number | 1578410031
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL & AESTHETICS, LLC
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Dates
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Enumeration Date | 03/13/2026
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Last Update Date | 03/13/2026
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Provider Practice Location Address
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Address Line | 7036 CERMAK RD
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City | BERWYN
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State | IL
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Zip | 60402-2197
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Country | US
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Telephone | 708-484-9145
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Fax |
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Provider Business Mailing Address
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Address Line | 4143 JOLIET AVE
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City | LYONS
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State | IL
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Zip | 60534-2070
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Country | US
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Telephone | 708-484-9145
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAIME MARTINEZ
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Credential | RN
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Telephone | 708-712-2151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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