Individual
DR. ELYSA WIDJAJA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3333 BURNET AVE, ML 5031, CINCINNATI, OH 45229-3026
(513) 636-4251
(513) 636-8145
Mailing address
3333 BURNET AVE, ML 5031, CINCINNATI, OH 45229-3026
(513) 636-4251
(513) 636-8145
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
036.161747
IL
2085P0229X
Pediatric Radiology Physician
Primary
35.155182
OH
2085R0202X
Diagnostic Radiology Physician
036161747
IL
Other
Enumeration date
11/04/2022
Last updated
02/12/2026
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