Individual
AGUSTINUS RUSHANAEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
A41710
CA
208800000X
Urology Physician
MD 00033485
WA
208800000X
Urology Physician
MD 10824
HI
208800000X
Urology Physician
OR MD 14298
OR
Other
Enumeration date
08/30/2006
Last updated
05/31/2016
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