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Providence, Glen Kenneth

CPSO#: 105248

MEMBER STATUS

Active Member as of 15 Dec 2014

CURRENT OR PAST CPSO REGISTRATION CLASS

Restricted as of 15 Dec 2014

Summary

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Former Name: No Former Name

Gender: Male

Languages Spoken: English

Education: Saba University School of Medicine, 2008

Practice Information

Primary Location of Practice

530 Tecumseh St
Dresden ON N0P 1M0
Phone: (519) 683-4479
Fax: (519) 683-2763 Electoral District: 01

Additional Practice Location(s)

180 McNaughton Ave W
Chatham ON N7L4Z7
Canada
Phone: 5193546400
County: County of Kent
Electoral District: 01

80 Grand Ave
Chatham ON N7M5L9
Canada
Phone: (519) 352-6400
County: County of Kent
Electoral District: 01

194 Talbot St W
Leamington ON N8H1N9
Canada
Phone: (519) 326-3603
County: County of Essex
Electoral District: 01

Professional Corporation Information

Corporation Name: Glen K. Providence Medicine Professional Corporation
Certificate of Authorization Status: Inactive: Jun 27 2021

Hospital Privileges

Hospital	Location
Chatham-Kent Health Alliance	Chatham
Erie Shores HealthCare	Leamington

Specialties

Specialty	Issued On	Type
Internal Medicine	Effective:15 Dec 2014	CPSO Recognized Specialist

Registration History

Action	Issue Date
First certificate of registration issued: Restricted certificate	Effective: 15 Dec 2014
Terms and conditions imposed on certificate by Registration Committee	Effective: 15 Dec 2014
Expiry date attached to certificate of registration.	Expiry Date: 06 May 2015
Terms and conditions amended by Registration Committee	Effective: 09 Jun 2016
Terms and conditions amended by Registration Committee	Effective: 24 Jun 2016

Practice Restrictions

Imposed By	Effective Date	Expiry Date	Status
Registration Committee	Effective: 24 Jun 2016		Active

 Dr.  Glen  Kenneth  Providence  may  practise  medicine  independently in
                  internal medicine.