TAMMY LYNN PROVATAS MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****29

License Status

ACTIVE

Business

Title

First Name

TAMMY

Middle

LYNN

Last Name

PROVATAS

Business Name

TAMMY LYNN PROVATAS MD

Original Issue Date

06/29/2024

Effective Date

06/29/2024

Expiration Date

07/31/2026

City

URBANA

State

Zip

61802

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/24/2026