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Search › Indiana › 207RC0200X

Christian Provenza

NPI 1659906741 · on the registry since 2020 · sole proprietor

Practice

Address
1120 West Michigan Street
Gatch Hall Office Cl 285
Indianapolis, IN 46202
Phone
(317) 278-0042
Clinicians at this address
115

Additional practice sites

  • 1265 Union Ave, Memphis, TN
  • 877 Jefferson Ave, Memphis, TN

Registry record

Primary taxonomy
207RC0200X
207RC0200X
Also registered as
207P00000X
Licence states on file
TN, IN
From the registry's licence fields, which are often incomplete.
Sex
Male
Record last updated
2025-07-11

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Indiana