Indiana
Professional Licensing Agency
Matthew Joseph Provenzano
Controlled Substance Registration - Physician
License number
01072216B
Date granted
03/19/2013
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
Porter Health System, 85 E US HWY 6, Valparaiso IN 46383
indianalicensing.org
ID 5929252
LAST UPDATED 2024-04-23 00:10:34 UTC
LAST UPDATED 2024-04-23 00:10:34 UTC
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