MEDICARE: NANCY MARTINEZ-AMINI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician		IL

General Provider Information

NPI Number	:	1871674184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY MARTINEZ-AMINI MD

Provider Business Mailing Address
First Line	:	5535 W CERMAK RD
Second Line	:
City	:	CICERO
State	:	IL
Zip	:	60804-2218
Country	:	US
Telephone Number	:	708-780-6030
Fax Number	:	708-780-6068

Provider Business Practice Location Address
First Line	:	5535 W CERMAK RD
Second Line	:
City	:	CICERO
State	:	IL
Zip	:	60804-2218
Country	:	US
Telephone Number	:	708-780-6030
Fax Number	:	708-780-6068

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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