MATTHEW T PROVENCHER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036115250

License Status

NOT RENEWED

Business

First Name

MATTHEW

Middle

Last Name

PROVENCHER

Suffix

Business Name

MATTHEW T PROVENCHER MD

Original Issue Date

02/15/2006

Effective Date

07/31/2006

Expiration Date

07/31/2008

City

CHICAGO

State

Zip

60612

County

COOK

Ever Disciplined

LastModifiedDate

07/05/2013