Provider Demographics
NPI:1316051899
Name:HAVELDA, CHRISTOPHER J (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:J
Last Name:HAVELDA
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:PO BOX 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-688-1330
Mailing Address - Fax:270-688-1338
Practice Address - Street 1:1301 PLEASANT VALLEY RD
Practice Address - Street 2:SUITE 202
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-9774
Practice Address - Country:US
Practice Address - Phone:270-417-7500
Practice Address - Fax:270-417-7509
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027600A207RI0011X
KY18921207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200010210AMedicaid
KY000000605847OtherCOOP HEALTH ANTHEM #
KY000000051226OtherANTHEM BCBS
KY64189210Medicaid
KY3397790Medicare PIN
KY0409401Medicare PIN
IN631130GMedicare PIN
KY0319304Medicare PIN
KY060030345Medicare PIN
IN200010210AMedicaid
KY0320401Medicare PIN