Provider Demographics
NPI:1578748802
Name:BUDIASIH, SANTI (MD)
Entity Type:Individual
Prefix:
First Name:SANTI
Middle Name:
Last Name:BUDIASIH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 S KOELLER ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-6214
Mailing Address - Country:US
Mailing Address - Phone:920-223-7200
Mailing Address - Fax:
Practice Address - Street 1:1855 S KOELLER ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-6214
Practice Address - Country:US
Practice Address - Phone:920-223-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-06
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54758208000000X
NE5584208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics