Individual
ANDRES JAVIER FANTAUZZI PORTELA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1950 W POLK ST STE 5210, CHICAGO, IL 60612-3723
(312) 864-0200
Mailing address
1950 W POLK ST STE 5210, CHICAGO, IL 60612-3723
(312) 864-0200
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
125086744
IL
207N00000X
Dermatology Physician
23339
PR
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/28/2019
Last updated
07/02/2025
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