Provider Demographics
NPI:1932102175
Name:HAVEMANN, CATHLEEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHLEEN
Middle Name:M
Last Name:HAVEMANN
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 1:4900 MUELLER BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3079
Mailing Address - Country:US
Mailing Address - Phone:512-324-0165
Mailing Address - Fax:512-324-0786
Practice Address - Street 1:4900 MUELLER BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-3079
Practice Address - Country:US
Practice Address - Phone:512-324-0165
Practice Address - Fax:512-324-0786
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2307208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143951512Medicaid
TX143951510Medicaid
TX8CT037OtherBCBS
TX143951509Medicaid
TX143951511Medicaid
TX143951512Medicaid
TX143951511Medicaid
TXTXB142813Medicare PIN