MATTHEW T PROVENCHER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****59

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

02/15/2006

Expiration Date

07/31/2008

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008