Margaret Provenza

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

036072887 Issued in IL

Practice address

1253 N Alpine Rd
Rockford, IL 61107

Phone

(779) 696-9201

NPI assigned

Jul 17, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Margaret Jove Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Interoperability endpoints

• Direct secure messaging: lfetsko1223911@direct.uwhealth.org

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613692800000",
    "number": "1457378283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 78866",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532788866",
            "telephone_number": "779-696-7150",
            "fax_number": "779-696-7342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1253 N ALPINE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "61107",
            "telephone_number": "779-696-9201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENZA",
        "first_name": "MARGARET",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2021-02-19",
        "certification_date": "2021-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IL",
            "license": "036072887",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036072887",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mprovenza921723@direct.uwhealth.org",
            "affiliation": "N",
            "address_1": "1253 N Alpine Rd",
            "city": "Rockford",
            "state": "IL",
            "country_code": "US",
            "postal_code": "61107",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARGARET",
            "last_name": "JOVE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Prohealth Pharmacy LLC
• Hunter Joseph Promer, DO
• Promotion Service LLC
• Sylwia Prorok, OD
• Camilla Provencher, RDN
• Ian Victor Provo
• Landon S Pryor, M.D.
• Daniel Psaltis, DC
• Nick D Psaltis, D.C.
• Psychiatric Associates of Rockford SC

• Otolaryngology Physician in Rockford, IL
• Providers in Rockford, IL by specialty
• Otolaryngology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.