| Doctor Name: | ANTONIUS SUSATYO HADI |
| NPI Number: | 1033296942 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 35046065 |
| Business Practice Address: | 8401 Market St Boardman, OH - 445126725 |
| Business Phone Number: | 3307294350 |
| Business Fax Number: | 3307294351 |
| Mailing Address: | Po Box 636988, CINCINNATI |
| State: | OH |
| Postal Code: | 452636988 |
| Phone Number: | 8889402722 |
| Fax Number: | 5136328898 |
| NPI Enumeration Date: | 11/01/2006 |
| NPI Last Update Date: | 09/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207V00000X |
| License Number: | 35046065 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |