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Individual

MARGARET PROVENZA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1253 N ALPINE RD, ROCKFORD, IL 61107
(779) 696-9201
Mailing address
PO BOX 78866, MILWAUKEE, WI 53278-8866
(779) 696-7150
(779) 696-7342

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
036072887
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036072887
IL
Enumeration date
07/17/2006
Last updated
02/19/2021
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