Provider Demographics
NPI:1386848455
Name:HABIMANA, PATRICIA MADJANI (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MADJANI
Last Name:HABIMANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 HIGHLANDER POINT DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-9465
Mailing Address - Country:US
Mailing Address - Phone:812-542-4921
Mailing Address - Fax:812-949-5966
Practice Address - Street 1:1850 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4990
Practice Address - Country:US
Practice Address - Phone:812-949-5790
Practice Address - Fax:812-949-5931
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY48221207LP2900X
IN01076843A207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYPENDINGMedicare UPIN
KYPENDINGMedicaid
KYPENDINGMedicare ID - Type Unspecified