CHRISTIAN PROVENZA

INDIANAPOLIS, IN
NPI1659906741
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy207RC0200X Internal Medicine, Critical Care Medicine
(Licence: IN  01096646A)
Additional Taxonomies207P00000X Emergency Medicine
(Licence: TN  67438)
Enumeration Date2020-03-09
Last Update Date2025-07-11
Business Address
CHRISTIAN PROVENZA
1120 WEST MICHIGAN STREET GATCH HALL OFFICE CL 285
INDIANAPOLIS, IN 46202
Phone number: 317-278-0042
Mailing Address
CHRISTIAN PROVENZA
1120 WEST MICHIGAN STREET GATCH HALL OFFICE CL 285
INDIANAPOLIS, IN 46202
Phone number: