Individual
CHRISTIAN PROVENZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1120 WEST MICHIGAN STREET, GATCH HALL OFFICE CL 285, INDIANAPOLIS, IN 46202
(317) 278-0042
Mailing address
1120 WEST MICHIGAN STREET, GATCH HALL OFFICE CL 285, INDIANAPOLIS, IN 46202
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
67438
TN
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
01096646A
IN
Other
Enumeration date
03/09/2020
Last updated
07/11/2025
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