MATTHEW J PROVENZANO

MICHIGAN CITY, IN
NPI1639388911
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207YP0228X Otolaryngology, Pediatric Otolaryngology
(Licence: IN  01072216A)
Additional Taxonomies207Y00000X Otolaryngology
(Licence: IN  01072216A)
207Y00000X Otolaryngology
(Licence: IA  36490)
207YP0228X Otolaryngology, Pediatric Otolaryngology
(Licence: OH  57.019215)
Enumeration Date2007-05-22
Last Update Date2023-08-24
Business Address
MATTHEW J PROVENZANO M.D.
1225 E COOLSPRING AVE STE 300
MICHIGAN CITY, IN 46360-6312
Phone number: 219-878-5032
Mailing Address
MATTHEW J PROVENZANO M.D.
PO BOX 781076
DETROIT, MI 48278-1076
Phone number: 317-528-4800