Healthcare Provider Details

I. General information

NPI: 1386848455
Provider Name (Legal Business Name): PATRICIA MADJANI HABIMANA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 STATE ST
NEW ALBANY IN
47150-4990
US

IV. Provider business mailing address

800 HIGHLANDER POINT DR SUITE 204
FLOYDS KNOBS IN
47119-9465
US

V. Phone/Fax

Practice location:
  • Phone: 812-949-5790
  • Fax: 812-949-5931
Mailing address:
  • Phone: 812-542-4921
  • Fax: 812-949-5966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberKY48221
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number01076843A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: