Individual
EVELINE RUSDIANTO KLENOTIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO, FACS
Contact information
Practice address
2600 SIXTH ST SW, CANTON, OH 44710-1702
(330) 344-6000
Mailing address
PO BOX 80690, CANTON, OH 44708-0690
(330) 363-7444
(330) 363-7770
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
34.011721
OH
208600000X
Surgery Physician
E-15091
AR
390200000X
Student in an Organized Health Care Education/Training Program
—
OH
Other
Enumeration date
04/04/2011
Last updated
07/19/2023
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