Matthew J Provenzano
Otolaryngologist (ENT Doctor) Pediatric Otolaryngology
1225 E Coolspring Ave Ste 300
Michigan City
, Indiana 46360-6312
Matthew J Provenzano
Otolaryngologist (ENT Doctor) Pediatric Otolaryngology
1225 E Coolspring Ave Ste 300
Michigan City
, Indiana 46360-6312
(317) 528-4800
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About
Features
Specialties
- Otolaryngologist (ENT Doctor)
- Pediatric Otolaryngology
Languages spoken
- English
Location
First Address
- Matthew J Provenzano
- Po Box 781076
- Detroit, MI
- Zip : 48278-1076
- Phone : (317) 528-4800
Second Address
- Matthew J Provenzano
- 1225 E Coolspring Ave Ste 300
- Michigan City, IN
- Zip : 46360-6312
- Fax : (219) 861-8151
- Phone : (219) 878-5032
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What type of doctor is Matthew J Provenzano
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Is Matthew J Provenzano a sole practitioner?
Is Matthew J Provenzano accepting new patients?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207Y00000X | Otolaryngologist (ENT Doctor) | 01072216A | IN |
| N | 207Y00000X | Otolaryngologist (ENT Doctor) | 36490 | IA |
| Y | 207YP0228X | Pediatric Otolaryngology | 01072216A | IN |
| N | 207YP0228X | Pediatric Otolaryngology | 57.019215 | OH |
National Provider Identifier
| NPI | 1639388911 |
|---|---|
| Provider Name | Matthew J Provenzano |
| First Address | Detroit, MI 48278-1076 |
| Second Address | Michigan City, IN 46360-6312 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 22/05/2007 |
| Last Update Date | 13/03/2021 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.