Provider Demographics
NPI:1902828296
Name:HATVANI, CATHERINE I
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:I
Last Name:HATVANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SIERRA DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7241
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:318-865-1479
Practice Address - Street 1:1012 N 14TH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2021
Practice Address - Country:US
Practice Address - Phone:765-448-6064
Practice Address - Fax:765-447-0484
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033000208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100181440Medicaid
IN220170FMedicare PIN
INP00166771Medicare PIN
IND95622Medicare UPIN