Hadi, Antonius Susatyo

Hadi, Antonius Susatyo is an individual health care provider with primary practice located at 8401 Market St , Boardman OH 44512-6725. He recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as his primary health care specialty. Hadi, Antonius Susatyo can be contacted via phone (330) 729-4350.

Contact Information

Primary practice address
8401 Market St Boardman OH 44512-6725
Phone: (330) 729-4350
Fax: (330) 729-4351
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 35046065 Ohio

Profile Details

NPI number 1033296942
LBN Legal business name Hadi, Antonius Susatyo
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 1st, 2006
Last updated Dec 28th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033296942 NPPES
Ohio Other H087621 MEDICARE PTAN
Ohio MEDICAID 2444519 MEDICARE PTAN

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