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1184285249
MICHAEL WIDJAJA
FRANKFORT, KY
NPI
1184285249
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207R00000X Internal Medicine
(Licence: KY 56540)
Enumeration Date
2019-06-27
Last Update Date
2022-08-11
Business Address
MICHAEL WIDJAJA MD
299 KINGS DAUGHTERS DR
FRANKFORT, KY 40601-4186
Phone number: 502-875-5240
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Mailing Address
MICHAEL WIDJAJA MD
2151 MEETING ST APT 12209
LEXINGTON, KY 40509-4662
Phone number: 347-749-8428
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