Individual
DR. NICOLAS FM PORTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
225 E CHICAGO AVE, CHICAGO, IL 60611-2991
(800) 543-7362
Mailing address
225 E CHICAGO AVE, CHICAGO, IL 60611-2991
(800) 543-7362
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
036100613
IL
2080N0001X
Neonatal-Perinatal Medicine Physician
036100613
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-100613
—
IL
Enumeration date
05/20/2006
Last updated
09/13/2024
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