Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MATTHEW J PROVENZANO, M.D.
ActiveMATTHEW J PROVENZANO, M.D. is a Pediatric Otolaryngology healthcare provider located in MICHIGAN CITY, Indiana. NPI 1639388911 is currently active in the NPPES registry. Verify at CMS.
Pediatric Otolaryngology · MICHIGAN CITY, IN
Registration Details
- NPI Number
- 1639388911
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- May 22, 2007 (19.261255186934 yrs)
- Last Updated
- Aug 24, 2023
- Licenses
-
01072216A (IN)36490 (IA)57.019215 (OH)01072216A (IN)
Practice Information
- Address
-
1225 E COOLSPRING AVE STE 300MICHIGAN CITY, IN, 463606312Browse IN providers · Browse ZIP 46360
- Phone
- 2198785032
- Fax
- 2198618151
- Primary Specialty
-
Pediatric Otolaryngology
207YP0228X
- Additional Specialty
- Otolaryngology
- Additional Specialty
- Pediatric Otolaryngology
- Additional Specialty
- Pediatric Otolaryngology
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.