Andres Javier Fantauzzi Portela, MD is a
Student In An Organized Health Care Education/training Program physician based in Chicago, Illinois. Andres Javier Fantauzzi Portela is licensed to practice in * (Not Available) (license number ) and his current practice location is 1950 W Polk St Ste 5210, Chicago, Illinois. He can be reached at his office (for appointments etc.) via phone at
(312) 864-0200.
NPI number for Andres Javier Fantauzzi Portela is 1457815086 and his current mailing address is 1950 W Polk St Ste 5210, Chicago, Illinois. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1457815086.
Physician's Profile
| Full Name | Andres Javier Fantauzzi Portela |
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| Gender | Male |
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| Speciality | Student In An Organized Health Care Education/training Program |
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| Location | 1950 W Polk St Ste 5210, Chicago, Illinois |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1457815086
- Provider Enumeration Date: 01/28/2019
- Last Update Date: 07/02/2025
Medical Identifiers
Medical identifiers for Andres Javier Fantauzzi Portela such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1457815086 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207N00000X | Dermatology | 23339 (Puerto Rico) | Secondary |
| 207N00000X | Dermatology | 125086744 (Illinois) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Andres Javier Fantauzzi Portela is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Andres Javier Fantauzzi Portela, MD
1950 W Polk St Ste 5210,
Chicago, IL 60612-3723
Ph: (312) 864-0200 | Andres Javier Fantauzzi Portela, MD
1950 W Polk St Ste 5210,
Chicago, IL 60612-3723
Ph: (312) 864-0200 |
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