Healthcare Provider Details

I. General information

NPI: 1891917720
Provider Name (Legal Business Name): PAOLA ANDREA PORTELA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 W FULLERTON AVE
CHICAGO IL
60647-2319
US

IV. Provider business mailing address

1909 MALLORY LN STE 203 SUITE 203
FRANKLIN TN
37067-2842
US

V. Phone/Fax

Practice location:
  • Phone: 773-782-2800
  • Fax: 773-782-5042
Mailing address:
  • Phone: 773-315-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number74246
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036123991
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: