Individual
MICHAEL WIDJAJA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
299 KINGS DAUGHTERS DR, FRANKFORT, KY 40601-4186
(502) 875-5240
Mailing address
2151 MEETING ST APT 12209, LEXINGTON, KY 40509-4662
(347) 749-8428
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
56540
KY
Other
Enumeration date
06/27/2019
Last updated
08/11/2022
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