Provenzano, Matthew J

Provenzano, Matthew J is an individual health care provider with primary practice located at 1225 E Coolspring Ave Ste 300 , Michigan City IN 46360-6312. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Otolaryngology, Allopathic & Osteopathic Physicians / Pediatric Otolaryngology. Allopathic & Osteopathic Physicians / Pediatric Otolaryngology is his primary health care specialty. Provenzano, Matthew J can be contacted via phone (219) 878-5032.

Contact Information

Primary practice address
1225 E Coolspring Ave Ste 300 Michigan City IN 46360-6312
Phone: (219) 878-5032
Fax: (219) 861-8151
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X 01072216A Indiana
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X 36490 Iowa
Allopathic & Osteopathic Physicians / Pediatric Otolaryngology 207YP0228X 57.019215 Ohio
Allopathic & Osteopathic Physicians / Pediatric Otolaryngology 207YP0228X 01072216A Indiana

Profile Details

NPI number 1639388911
LBN Legal business name Provenzano, Matthew J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 22nd, 2007
Last updated Aug 24th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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