| | Physician Last Name: | Provines |
| | Physician First Name: | Michael |
| | Physician Middle Name: | Wynn |
| | Address: | 754 Huntington Avenue #4
Boston, Massachusetts 02115 |
| | License Number: | 220655 |
| | License Type: | MD |
| | Year of Birth: |
1970
|
| | Effective Date: | 06/10/2002 |
| | Action Description for DOH Webpage: | Ninety days notice before resuming the practice of medicine in New York State with probation for five years commencing upon the physician resuming the practice of medicine in New York State. |
| | Misconduct Description for DOH Webpage: | The Hearing Committee sustained the charges finding the physician guilty of obtaining a license fraudulently;practicing fraudulently;engaging in conduct which evidences moral unfitness;making or filing a false report and having been disciplined by the Massachusetts State Board of Registration in Medicine. |
| | License Limitations or Conditions for DOH Webpage: | |
| | Board Order: |
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