Individual
KATHLEEN MICHELLE PROVANZANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6 LEXINGTON BLVD, DELAWARE, OH 43015-1047
(740) 363-3305
(740) 383-7942
Mailing address
6 LEXINGTON BLVD, DELAWARE, OH 43015-1047
(740) 363-9021
(740) 363-7962
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35071152P
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0104351
UHC
—
01
—
080122321
TRAVELERS MEDICARE
—
01
—
0855442
PALMETTO MEDICARE
—
01
—
2025334
AETNA
—
05
—
2074133
—
OH
01
—
311098079
TAX ID PHYS AND NON PHYS
—
01
—
311098079240
CIGNA
—
01
—
353077
SUBMITTER NO.
—
Enumeration date
06/09/2006
Last updated
02/20/2024
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