Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

John Michael Provenza, MD

Individual provider Gastroenterology Physician · NPI 1508399346

John Michael Provenza, MD is a Gastroenterology in Winston Salem, North Carolina. Graduated from Louisiana State University School of Medicine in Shreveport in 2013, 13 years ago. Practices with Wake Forest University Health Sciences, a 2,621-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in North Carolina.

Years since qualifying
13
Trained at
Louisiana State University School of Medicine in Shreveport
Licensed in
NC
In the registry since
2017
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

See every abbreviation used in this directory →

Practice location Partly verified

Some contact details are missing from the federal record.

Medical Center Blvd
Winston Salem, NC 27157-1900
Phone: (336) 713-7311
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 625 19th St S, Birmingham, AL 35233-1900 — (205) 934-9666

Specialties & licences

Gastroenterology Physician (primary) Taxonomy 207RG0100X · Licence 2023-01626 (NC)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1508399346
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 8, 2017
Last updated in NPPESJune 12, 2023
Certification dateJune 12, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyGASTROENTEROLOGY
Medical schoolLOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN SHREVEPORT
Graduated 2013 (13 years in practice)
Group practice Wake Forest University Health Sciences — 2621 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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