Individual
JOEL D PROVENZANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1040 DELAWARE AVE, MARION, OH 43302-6416
(740) 375-8135
(740) 375-6468
Mailing address
1040 DELAWARE AVE, MARION, OH 43302-6416
(740) 375-8135
(740) 375-6468
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
35.099189
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0071205
—
OH
Enumeration date
07/30/2009
Last updated
12/15/2021
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