Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Elysa Widjaja, MD

Individual provider Pediatric Radiology Physician · NPI 1184331522

Dr. Elysa Widjaja, MD is a Pediatric Medicine in Cincinnati, Ohio. Qualified in 1995, 31 years ago. Practices as a sole proprietor and works from 3 locations. Licensed in Illinois and Ohio.

Years since qualifying
31
Licensed in
IL, OH
In the registry since
2022
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

3333 Burnet Ave Ml 5031
Cincinnati, OH 45229-3026
Phone: (513) 636-4251
Fax: (513) 636-8145
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • Lurie Children'S Hospital, Chicago, IL 60611 — (312) 227-3475
  • 676 N Saint Clair St Ste 800, Chicago, IL 60611-2978 — (312) 695-5753

Specialties & licences

Pediatric Radiology Physician (primary) Taxonomy 2085P0229X · Licence 35.155182 (OH)
Pediatric Radiology Physician Taxonomy 2085P0229X · Licence 036.161747 (IL)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence 036161747 (IL)

Record details

NPI number1184331522
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorYes
NPI enumeratedNovember 4, 2022
Last updated in NPPESFebruary 12, 2026
Certification dateFebruary 12, 2026
Mailing address3333 Burnet Ave, Ml 5031, Cincinnati, OH 45229-3026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPEDIATRIC MEDICINE
Medical schoolOTHER
Graduated 1995 (31 years in practice)
Accepts Medicare assignment Not indicated

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