Robert Provenzano (NPI# 1972505584, PAC ID# 2163310095) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NEPHROLOGY.
| Nation Provider ID (NPI) | 1972505584 |
| PAC ID by PECOS | 2163310095 |
| Professional Enrollment ID | I20110331000737 |
| Full Name | Robert Provenzano |
| Organization Legal Name | ST CLAIR SPECIALTY PHYSICIANS PC |
| Address |
5610 W Gage Boise ID 83706-1332 |
| Phone Number | 2083673370 |
| Gender | M |
| Medical School | WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE |
| Graduation Year | 1983 |
| Primary Specialty | NEPHROLOGY |
| Secondary Specialties | INTERNAL MEDICINE |
| Group Practice PAC ID | 6204733256 |
| Number of Group Practice Members | 33 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 230165 | ST JOHN HOSPITAL AND MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 5610 W Gage, Boise, ID 83706-1332 | 2083673370 | ST CLAIR SPECIALTY PHYSICIANS PC |
| 5610 W Gage, Suite A, Boise, ID 83706-1332 | 2083673370 | ST CLAIR SPECIALTY PHYSICIANS PC |
| 22201 Moross Rd, Suite 170, Detroit, MI 48236-2152 | 3138868787 | ST CLAIR SPECIALTY PHYSICIANS PC |
| 22201 Moross Rd, Detroit, MI 48236-2152 | 3138868787 | ST CLAIR SPECIALTY PHYSICIANS PC |
| Organization Legal Name | ST CLAIR SPECIALTY PHYSICIANS PC |
| Physicians | 32 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Mina El Kateb | Nephrology | St Clair Specialty Physicians PC | 16151 19 Mile Rd, Clinton Township, MI 48038-1158 |
| Heather L Henderson | Nephrology | St Clair Specialty Physicians PC | 18001 E 10 Mile Rd, Roseville, MI 48066-3803 |
| Christopher J Sjoberg | Nurse Practitioner | St Clair Specialty Physicians PC | 5610 W Gage, Suite A, Boise, ID 83706-1332 |
| Micheal J Adcox | Nephrology | St Clair Specialty Physicians PC | 515 E Lane, Ontario, OR 97914-3953 |
| Angela Ruth Harker Bacchus | Nurse Practitioner | St Clair Specialty Physicians PC | 23857 Greenfield Rd, Southfield, MI 48075-3122 |
| Abida Zafar | Nephrology | St Clair Specialty Physicians PC | 4180 Hospital Dr, East China, MI 48054-2233 |
| Diana Scanlon | Nurse Practitioner | St Clair Specialty Physicians PC | 15918 19 Mile Rd, Clinton Township, MI 48038-1101 |
| Gudalia Alcantara Fajardo | Nurse Practitioner | St Clair Specialty Physicians PC | 2601 Electric Ave, Port Huron, MI 48060-6587 |
| Saurabh Gandhi | Internal Medicine | St Clair Specialty Physicians PC | 15918 19 Mile Rd, Clinton Township, MI 48038-1101 |
| Ameer Abdulrazzak | Nephrology | St Clair Specialty Physicians PC | 28300 Orchard Lake Rd, Suite 202, Farmington Hills, MI 48334-3704 |
| Street Address |
5610 W GAGE |
| City | BOISE |
| State | ID |
| Zip | 83706-1332 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Christopher J Sjoberg | Nurse Practitioner | St Clair Specialty Physicians PC | 5610 W Gage, Suite A, Boise, ID 83706-1332 |
| Mark David Poirier | Nephrology | St Clair Specialty Physicians PC | 5610 W Gage, Suite A, Boise, ID 83706-1332 |
| Thomas Joseph Pintar | Nephrology | St Clair Specialty Physicians PC | 5610 W Gage, Suite A, Boise, ID 83706-1332 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Sharon L Saul | Clinical Social Worker | 3350 Americiana Blvd, Suite 210b, Boise, ID 83706 | |
| Afshin Mofid | Chiropractic | 880 N Curtis Rd, Boise, ID 83706-1306 | |
| James W Kranz | Chiropractic | 910 N Curtis Rd, Boise, ID 83706-1308 | |
| Kenneth C Stratton Jr. | Certified Registered Nurse Anesthetist (crna) | Boise Anesthesia, Pa | 1055 N Curtis Rd, Boise, ID 83706-1309 |
| Kyle P Noorlander | Certified Registered Nurse Anesthetist (crna) | Boise Anesthesia, Pa | 1055 N Curtis Rd, Boise, ID 83706-1309 |
| Robert L Petersen | Hospitalist | Saint Alphonsus Regional Medical Center Inc | 1055 N Curtis Rd, Boise, ID 83706-1309 |
| Brett E Curley | Certified Registered Nurse Anesthetist (crna) | Boise Anesthesia, Pa | 1055 N Curtis Rd, Boise, ID 83706-1309 |
| Dianna Lee Binnion | Emergency Medicine | Cep America LLC | 1055 N Curtis Rd, Boise, ID 83706-1309 |
| Charles M Reynolds | Emergency Medicine | Cep America LLC | 1055 N Curtis Rd, Boise, ID 83706-1309 |
| Shane Kenneth Marshall | Emergency Medicine | Cep America LLC | 1055 N Curtis Rd, Boise, ID 83706-1309 |
| Find all physicians in zip 83706 | |||
| City | BOISE |
| Zip Code | 83706 |
| Specialty | NEPHROLOGY |
| City + Specialty | BOISE + NEPHROLOGY |
Please comment or provide details below to improve the information on Robert Provenzano.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.