ANDRES FANTAUZZI PORTELA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125086744

License Status

ACTIVE

Business

Title

First Name

ANDRES

Last Name

FANTAUZZI PORTELA

Business Name

ANDRES FANTAUZZI PORTELA MD

Original Issue Date

07/01/2025

Effective Date

07/01/2025

Expiration Date

06/30/2026

City

CHICAGO

State

Zip

60612

Specialty/Qualifier

Dermatology

Ever Disciplined

LastModifiedDate

06/13/2025