ROBERT PROVENZANO MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036167442

License Status

ACTIVE

Business

Title

First Name

ROBERT

Last Name

PROVENZANO

Business Name

ROBERT PROVENZANO MD

Original Issue Date

10/24/2023

Effective Date

10/24/2023

Expiration Date

07/31/2026

City

GROSSE POINTE PARK

State

Zip

48230

Ever Disciplined

LastModifiedDate

03/24/2026