Individual
CHRISTOPHER ROBERT PROVENZANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
45650 SCHOENHERR RD, SHELBY TOWNSHIP, MI 48315-6033
(586) 286-7800
(586) 286-7804
Mailing address
45640 SCHOENHERR RD, SUITE B, SHELBY TOWNSHIP, MI 48315-6033
(586) 247-4300
(586) 532-6496
Taxonomy
Speciality
Code
Description
License number
State
207RH0005X
Hypertension Specialist Physician
4301082092
MI
207RN0300X
Nephrology Physician
Primary
4301082092
MI
207RN0300X
Nephrology Physician
49048
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CP4301082092
STATE LICENSE
MI
Enumeration date
03/28/2008
Last updated
10/27/2015
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