- Practice location
- 1950 W Polk St Ste 5210, Chicago, IL 60612-3723
- Phone
- 312-864-0200
- Fax
- —
- Last updated
- July 2, 2025
Andres Javier Fantauzzi Portela is a Student in an Organized Health Care Education/Training Program based in Chicago, IL. Andres Javier Fantauzzi Portela practices in Chicago, IL and has the professional credentials of MD. The NPI Number for Andres Javier Fantauzzi Portela is 1457815086 and holds a License No. 23339 (PR). The current practice location address for Andres Javier Fantauzzi Portela is 1950 W Polk St Ste 5210, Chicago, IL 60612-3723 and can be reached out via phone at 312-864-0200.
Provider Profile Details
- NPI Number
- 1457815086
- Provider Name
- Andres Javier Fantauzzi Portela
- Credential
- MD
- Provider Entity Type
- Individual
- Gender
- Male
- Address
- 1950 W Polk St Ste 5210, Chicago, IL 60612-3723
- Phone Number
- 312-864-0200
- Primary Taxonomy
- Student in an Organized Health Care Education/Training Program · 390200000X
- Sole Proprietor
- No
- Provider Enumeration Date
- January 28, 2019
- Last Update Date
- July 2, 2025
- Certification Date
- July 2, 2025
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 1950 W Polk St Ste 5210
Chicago, IL 60612-3723 - City
- Chicago
- State
- Illinois
- Zip
- 60612-3723
- Phone Number
- 312-864-0200
Provider Business Mailing Address Details
- Address
- 1950 W Polk St Ste 5210
Chicago, IL 60612-3723 - City
- Chicago
- State
- IL
- Zip
- 60612-3723
- Phone Number
- 312-864-0200
License Information
- License Number (1)
- 23339
- License State (1)
- PR
- Taxonomy (1)
- Dermatology · 207N00000X
- License Number (2)
- 125086744
- License State (2)
- IL
- Taxonomy (2)
- Dermatology · 207N00000X
- Taxonomy (3)
- Student in an Organized Health Care Education/Training Program · 390200000X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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Frequently Asked Questions
What is the NPI number of Andres J Fantauzzi Portela, MD?
The NPI number of Andres J Fantauzzi Portela, MD is 1457815086. It was assigned on January 28, 2019 and is currently active in the NPPES registry.
What is the specialty of Andres J Fantauzzi Portela, MD?
Andres J Fantauzzi Portela, MD is registered under the primary taxonomy Student in an Organized Health Care Education/Training Program (code 390200000X), licensed in PR under license number 23339.
Where does Andres J Fantauzzi Portela, MD practice?
The practice location is 1950 W Polk St Ste 5210, Chicago, IL 60612-3723. The office can be reached at 312-864-0200 (phone).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1457815086 directly on the NPPES registry website.