Provider Demographics
NPI:1982667291
Name:HAVENS, STEPHEN REEVES (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:REEVES
Last Name:HAVENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 SPARKS AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3739
Mailing Address - Country:US
Mailing Address - Phone:812-283-4441
Mailing Address - Fax:812-288-2605
Practice Address - Street 1:207 SPARKS AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3739
Practice Address - Country:US
Practice Address - Phone:812-283-4441
Practice Address - Fax:812-288-2605
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032889A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4237775OtherAETNA
0101169OtherUNITED HEALTHCARE
IN100149740AMedicaid
IN020012986OtherRAILROAD MEDICARE
000000042280OtherANTHEM
IN020012986OtherRAILROAD MEDICARE
4237775OtherAETNA