Healthcare Provider Details

I. General information

NPI: 1174146138
Provider Name (Legal Business Name): CLAUDIA ANGELA SETIAWAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date: 01/18/2022
Reactivation Date: 02/22/2022

III. Provider practice location address

525 WESTERN AVE STE 305A
CONWAY AR
72034-4982
US

IV. Provider business mailing address

PO BOX 9662
CONWAY AR
72033-9662
US

V. Phone/Fax

Practice location:
  • Phone: 501-358-6145
  • Fax: 501-504-6642
Mailing address:
  • Phone: 501-852-1363
  • Fax: 501-852-1364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberE20598
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: