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Iwan S Nyotowidjojo

Debarred entity
TypePerson[sources]
NameIwan S Nyotowidjojo[sources]
Birth datenot available[sources]
Nationalitynot available[sources]
CountryUnited States of America[sources]
First nameIwan[sources]
Last nameNyotowidjojo[sources]
Middle nameS[sources]
NPI1578976270[sources]
SectorPhysician[sources]
AddressIrvine, CA, MI[sources]
Last changeLast processedFirst seen

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Data sources

US Michigan Medicaid Sanctioned Provider List3,878

Providers who have been terminated for cause from Michigan's Medicaid program.

United States of America · MDHHS


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