Individual provider · Type 1 NPI

Andres Javier Fantauzzi Portela, MD

Student in an Organized Health Care Education/Training Program · Chicago, IL

NPI number 1457815086 Active

Practice location

1950 W Polk St Ste 5210
Chicago, IL 60612-3723

Call (312) 864-0200 Map

Other practice locations

  • 388 Zona Ind Reparada 2, Ponce, PR 00716-2347 · (787) 840-2575
  • F19 Calle Reina Victoria, Guaynabo, PR 00969-5291 · (787) 696-1664

Specialties and licenses

TaxonomyCodeLicense
Dermatology Physician 207N00000X23339 (PR)
Dermatology Physician 207N00000X125086744 (IL)
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

24 other providers at this address

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About NPI 1457815086

Andres Javier Fantauzzi Portela, MD's National Provider Identifier is 1457815086, issued on Jan 28, 2019. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Chicago, IL. The record was last updated on Jul 2, 2025.