Individual
MANUEL ENRIQUE PORTALATIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 216-9000
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 216-9000
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036156256
IL
208600000X
Surgery Physician
282996
MA
208600000X
Surgery Physician
DO01505
RI
2086S0102X
Surgical Critical Care Physician
282996
MA
2086S0102X
Surgical Critical Care Physician
DO01505
RI
Other
Enumeration date
06/23/2014
Last updated
11/19/2025
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