No
Urut |
No
Angg |
Gelar |
Nama
|
Tempat,
Tanggal lahir
|
Agama
|
Pendidikan |
Alamat
Rumah |
Alamat
Praktek |
Keluarga |
Telp & HP |
| 1 |
051 |
Dr |
Dr T Linaya Sp.P(K)
|
Malang
26-10-17
|
|
|
Umum
|
: UNAIR,
1955
|
|
Spesialis
|
: UNAIR, 1968
|
|
Musi 22
Surabaya 60241 |
|
|
|
| 2 |
053 |
Dr |
Tjitra
Sutedja Sp.P
 |
Malang
05-07-24
|
Budha
|
|
Umum
|
: UNAIR,
1961
|
|
Spesialis
|
: UNAIR, 1967
|
|
Samudra
32 - 34 Surabaya |
|
Ny. Ina
Tanuhardja (i)
Dr Budi Sutedja, Sp.P
Muljono, Drg. |
Telp 031
- 3522923 |
| 3 |
055 |
Prof Dr |
Adji
Widjaja Sp.P(K) FCCP
 |
Surabaya
06-02-37
|
Katolik
|
|
Umum
|
: UNAIR,
1965
|
|
Spesialis
|
: UNAIR, 1971
|
| DR/Prof |
:
Belanda, 1979 |
|
Seruni
28 Surabaya 60272 |
Praktik
Pribadi, Jl. Seruni 28 - Surabaya
Klinik Widjaja Asthma Center-Surabaya
RS Adi Husada - Surabaya |
Dr Enny
Susilowati (i)
Ir. Eri Kurniawan Widjaja
Ir. Yanuar Harman Widjaja |
Telp 031
- 5346397
HP 0811 - 321 1087 |
| 4 |
056 |
Prof DR
Dr |
Thomas
VM Kardjito Sp.P (K)
|
Nganjuk
16-07-38
|
Katolik
|
|
Umum
|
: UNAIR,
1966
|
|
Spesialis
|
: UNAIR , 1971
|
| DR/Prof |
: 1988 |
|
Mojo
Klanggru Kidul D 17-19 Surabaya 60285 |
- |
Ny.
Maria Immaculata Subekti (i)
Albertus Agung Radjito, ST
Dr Angela Mayasari Sardjito
Dr H. Gunawan Kardjoto
|
Telp 031
- 5995466 |
| 5 |
057 |
Prof. Dr
|
Sayid
Hood Alsagaff Sp.P(K)
 |
Padang
14-06-42
|
Islam
|
|
Umum
|
: UNAIR,
1967
|
|
Spesialis
|
: UNAIR, 1973
|
| DR/Prof |
: UNAIR |
|
Kapuas
16 Surabaya 60265 |
RS
Dharmo - Surabaya
RS Husada Utama - Surabaya
Praktik Pribadi Jl. Kapuas 16 Surabaya |
Prof. Dr
Juliati Soedjono (i)
Dr Moch Thaha
Dr Lukman Hakim
Dr Achmad Rheza
Dr Moch Yusuf
Vira Yasmina |
Telp 031
- 5674365
HP 0816 - 503210 |
| 6 |
059 |
Dr |
Djoko
Iman Santoso Sp.P(K)
 |
Gambiran
15-01-34
|
Islam
|
|
Umum
|
: UNAIR,
1966
|
|
Spesialis
|
: UNAIR, 1973
|
|
Airlangga
I / 8 Surabaya 60268 |
RS PT.
KAI DAOP VIII Surabaya
RS Surabaya Internasional
Lab. Diagnostik Sutama Pramita Surabaya |
-
Nusa Damba Ika
Chandra Nusantariksa
Ima Savitri
Wasita Adi |
Telp 031
- 507270
HP 0813-138666 |
| 7 |
060 |
Dr H |
Abdul
Mukty Sp.P (K)
 |
Surabaya
19-11-35
|
Islam
|
|
Umum
|
: UNAIR,
1965
|
|
Spesialis
|
: UNAIR, 1975
|
|
Vila
Valencia CA 2/3 Lontar Surabaya 60216 |
RS Islam
I - Surabaya
RS Al-Irsyad - Surabaya
RS PHC - Surabaya |
RA.
Mustokoweni Dyah Anggraeni (i)
Rachmat Santosa
Dr Dwi Hariadi
Dr Muh. Yogiyo Pranoto, Sp.B
Syahron Nahar, ST
Achmad Syaikhu
Muh. Chandra Purnama
Dhalia Purnamasari, ST |
Telp 031
- 7525542
HP 0817-5056687 |
| 8 |
065 |
Prof DR
Dr |
Benyamin
P Margono Sp.P(K) FCCP
 |
Surabaya
19-11-35
|
Katolik
|
|
Umum
|
: UNAIR,
1971
|
|
Spesialis
|
: UNAIR, 1976
|
| DR/Prof |
: UNAIR,
1980 |
|
Jemur
Andayani 9 Surabaya 60237 |
RS
Siloam Hospital - Surabaya
RSUD Dr Soetomo - Surabaya |
Ny.
Ingrid Anastasia (i)
Iwan
David |
Telp 031
- 8415321
HP 0811 - 312 793 |
| 9 |
067 |
Dr |
Singgih
Sp.P
|
Randublatung
02-04-23
|
|
|
Umum
|
: UNAIR,
1955
|
|
Spesialis
|
: UNAIR, 1971
|
|
|
|
|
|
| 10 |
068 |
Dr |
Sahim
Rusdiah Sp.P
|
Pasuruan
23-05-29
|
|
|
Umum
|
: UNAIR,
1960
|
|
Spesialis
|
: UNAIR, 1967
|
|
Kacapiring
11 Surabaya 60272 |
|
|
|
| 11 |
069 |
Dr H |
Slamet
Hariadi Sp.P(K)
 |
Ponorogo
22-09-46
|
Islam
|
|
Umum
|
: UNAIR,
1972
|
|
Spesialis
|
: UNAIR, 1978
|
|
Raya
Buduran 22 Sidoarjo |
RSUD Dr
Soetomo - Surabaya
Praktik Pribadi Jl. Mangundiprojo 22-24 Sidoarjo |
|
|
| 12 |
070 |
Prof DR
Dr |
Muhammad
Amin, Sp.P(K)
 |
Gresik
10-08-47
|
Islam
|
|
Umum
|
: UNAIR,
1973
|
|
Spesialis
|
: UNAIR, 1978
|
| DR/Prof |
: UNAIR,
1994 |
|
Jemur
Sari Utara V - 30 Surabaya 60237 |
RS
William Booth-Surabaya
RSUD Dr Soetomo-Surabaya
RS St. Vincentius A Paulo-Surabaya |
Ny.
Farida Hanim (i)
Raditya Sukmana, SE, MA
Indira Retno Aryati, SH, MM
Erika Marfiani, SKed |
Telp 031
- 8420905
HP 0816 - 516240 |
| 13 |
071 |
Dr H |
Samsul
Harun Alrasjid, Sp.P(K)
 |
Probolinggo
07-04-36
|
Islam
|
|
Umum
|
: UNAIR,
1966
|
|
Spesialis
|
: UNAIR, 1979
|
|
Dharmahusada
Utara III / 10 Surabaya 60285 |
RS, Jl
Karangmenjangan 98 Surabaya
RS, Jl Raya Kenongo 22 Sidoarjo |
Dr
Ekowati, Sp.KK (i)
Achmad Setyahadi, SE
Dian Setyastuti, SE
Dini Arifiani, SH
Dina Arifiana, SH
Debi Setyawati, S.SOS |
Telp 031
- 5941888
HP 0818-516322 |
| 14 |
073 |
Dr |
M Yusuf
Wibisono Sp.P(K)
 |
Boyolali
02-01-47
|
Islam
|
|
Umum
|
: UNAIR,
1973
|
|
Spesialis
|
: UNAIR, 1979
|
|
Barata
Jaya XX / 66 Surabaya |
RSUD Dr
Soetomo Surabaya
RS Arofah - Mojokerto |
Ny.
Retnowati (i)
AKP. M. Hari Agung Julianto, S.Psi
Dr A. R. Retnowulan
M. Patasari Novianto |
Telp 031
- 504 1733
HP 08123114819 |
| 15 |
074 |
Dr |
Suratman
T. Karim Sp.P(K)
|
Surabaya
16-03-
|
Islam
|
|
Umum
|
: UNAIR,
1966
|
|
Spesialis
|
: UNAIR, 1978
|
|
Kemayoran
Baru 56 Surabaya |
Praktik
Pribadi Jl. Grambnan Baru 42 Surabaya |
Dra.
Nurjanah (i)
Dr Lita Anastasia Pelita
Drh. Liza Nuzul Sofiani
Liva Habiba, Ssos
Erwin Zulkarnain, ST
Laila Rahmawati, SH |
Telp 031
- 3521488 |
| 16 |
075 |
Dr |
Sumarno
Sp.P(K)
 |
Buyaran
Demak
01-10-39
|
Islam
|
|
Umum
|
: UI,
1965
|
|
Spesialis
|
: USU, 1978
|
|
Jemursari
III/ 11 Surabaya 60237 |
RS
Surabaya Internasional-Surabaya
RS Siti Khodijah-Surabaya
Klinik Jonggolo - Surabaya |
Ny.
Aniek Wuriyati Rukmini (i)
Erick Noviantoro, SE, MM
Gumar Priyantoro, ST, MMT
Dr Krisna Indrawanto
Iris Puspitasari, SE |
Telp 031
- 8493439
HP 0818 - 314939 |
| 17 |
078 |
Dr |
Achmad
Muchidin Razak Sp.P
 |
Probolinggo
18-08-41
|
Islam
|
|
Umum
|
: UNAIR,
1968
|
|
Spesialis
|
: UNAIR, 1982
|
|
Ngagel
Dadi SA/20 Surabaya 60245 |
Klinik
Medika Yani Group-Surabaya
Klnik Jl. AH Nasution No. 6 -Probolinggo
Klinik Jl. Panglima Sudirman-Kraksaan |
Ny.
Suharti (i)
Dina Indah Susanti
Dodyantorodwi SM
Donny Ivanto Tri W |
Telp
031-5056314
HP 0812-3450491 |
| 18 |
079 |
Dr |
Amin
Aryono Sp.P
|
13-06-33
|
Islam
|
|
Umum
|
: UNAIR,
1965
|
|
Spesialis
|
: UNAIR, 1982
|
|
Brawijaya
27 Surabaya |
Praktik
Pribadi Jl. Mangunegoro 7 Surabaya |
Ny.
Roostien (i)
Rizky Sardianto, ST, MM
Ranti Arzsilia, SH, Notariat
Dendi Prihandono, ST, MM |
Telp 031
- 567 7659
HP 0818 - 596364 |
| 19 |
164 |
DR Dr |
J.F.
Palilingan Sp.P(K)
 |
Surabaya
06-10-44
|
Katolik
|
|
Umum
|
: UNAIR,
1967
|
|
Spesialis
|
: UNAIR, 1984
|
| DR/Prof |
: UNAIR,
2001 |
|
Ngagel
Jaya Selatan II 22 Surabaya |
RSUD Dr
Soetomo - Surabaya
RKZ St Vincentius a Paulo - Surabaya |
Dr
Lindawati Alimsardjono, M.Kes, Sp.MK (i)
Rudolf Palilingan, ST
Robertus Palilingan, ST
Elizabeth Vania Palilingan |
Telp 031
- 5682925
HP 0812-3203396 |
| 20 |
168 |
Dr |
Kemas M
Adil Sp.P(K)
|
03-04-45
|
|
|
Umum
|
: UNAIR,
1972
|
|
Spesialis
|
: UNAIR, 1986
|
|
Ampel
Kejeron I / 20 Surabaya 60151 |
|
|
|
| 21 |
171 |
Dr |
Indra
Pinarta Sp.P
 |
Bojonegoro
26-04-45
|
Kristen
|
|
Umum
|
:
UNIBRAW, 1976
|
|
Spesialis
|
: UNAIR, 1986
|
|
Dr
Soetomo 55 Madiun 63116 |
Praktik
Pribadi Jl. Dr Soetomo 55 Madiun
RS Santa Clara-Madiun
RS Siti Asih-Madiun |
Ny.
Maria Margaretha Limaningsih (i)
Stefanus Pinarta
Henry Dwi Kurniawan Pinarta |
Telp
0351 - 451064
HP 0816561970 |
| 22 |
188 |
Dr |
Sri
Prihatini Boestan Sp.P(K)
|
Yogyakarta
26-05-45
|
Islam
|
|
Umum
|
: UGM ,
1970
|
|
Spesialis
|
: UNAIR, 1986
|
|
Rungkut
Mejoyo Selatan VIII / 21 Surabaya 60292 |
- |
Prof. Dr
Iwan N. Boestan, SpJP(K), FIHA (s)
Tarakanita Bernadette Boestan Kenny, BSc
Tararina Boestan, MSc
Gatot Rintawan Boestan, BSc |
Telp 031
- 843 4200, 8417390
HP 0818-950085 |
| 23 |
195 |
Dr |
Kasdi
Soepadmo Sp.P
 |
Lumajang
31-05-47
|
Islam
|
|
Umum
|
: UNAIR,
1976
|
|
Spesialis
|
: UNAIR, 1990
|
|
Perum
Gajah Mada Jl. RA Kartini Blok F 16 Pare Kediri |
HVA
Tulungrejo - Pare
RS Amelia - Pare Kediri
Praktik Pribadi Jl. Kartini - Pelem Pare |
Ny.
Petronela Adelaida (i)
Luki Diah Mursanti, S.Sos |
Telp
0354 - 391946 |
| 24 |
196 |
Dr |
Susanti
Sp.P
|
Malang
24-04-50
|
|
|
Umum
|
:
UNIBRAW, 1979
|
|
Spesialis
|
: UNAIR, 1989
|
|
Dharmahusada
Utara IV / 10 Surabaya |
|
|
|
| 25 |
211 |
Dr |
Donny
Irawan Sp.P
|
Surabaya
28-11-81
|
Katolik
|
|
Umum
|
:
UDAYANA , 1978
|
|
Spesialis
|
: UNAIR, 1990
|
|
Manyar
Kertoarjo VII / 14 Surabaya 60285 |
RS
Internasional - Surabaya
Praktik Pribadi Jl. Kalianyar 50 - Surabaya
RS Adi Husada - Surabaya |
Ir.
Shery Aryani Arya (i)
Ariston Irawan, BA
Resha Irawan, BA |
Telp 031
- 5941573
HP 0811329722
|
| 26 |
213 |
Dr H |
Sofyan
Hasan Siregar Sp.P
 |
Labuhan
Bilik
27-07-47
|
Islam
|
|
Umum
|
: USU,
1981
|
|
Spesialis
|
: UNAIR, 1991
|
|
KH.
Zainal Alim 32 Bangkalan |
RS Prof.
Dr Setiawan Kertosudirjo-Bangkalan
Praktik Pribadi Jl. Zainal Alim 32-Bangkalan |
Dr Ima
Wiryani, Sp.THT (i)
Fahmi Wardhana
Sofia Tiarini
Fanny Sarasati |
Telp 031
- 309 7006
HP 0818318265 |
| 27 |
215 |
Dr |
Handojo
Padmosoeparto, MSc, Sp.P
 |
Mojokerto
20-01-37
|
Islam
|
|
Umum
|
: UNAIR,
1966
|
|
Spesialis
|
: UNAIR, 1991
|
|
Trenggilis
Utara 8 / 2 Surabaya |
RS PHC
Tanjung Perak - Surabaya |
Sri
Kurniati, BcHK (i)
Dr Titisari Handayani
R. Handi Setioko, S.Psi
Dr R. Handi Priambodo
Dr R. Handi Sembodo |
Telp 031
- 8432482
HP 081330720675 |
| 28 |
217 |
Dr |
Isnu
Pradjoko Sp.P(K)
 |
Blitar
22-08-50
|
Islam
|
|
Umum
|
: UNAIR,
1977
|
|
Spesialis
|
: UNAIR, 1991
|
|
Ngagel
Madya VII / 9 & 11 Surabaya 60284 |
RSUD Dr
Soetomo - Surabaya
Klinik Kimia Farma 23 - Surabaya
RS Privata - Surabaya |
Ny. Umi
Naskah (i)
Hatief Pradananta
Dwinanto Ananda Muttaqin
Kemala Purbani |
Telp 031
- 5041218
HP 0818 - 393396 |
| 29 |
218 |
Dr |
Soewedo
WS Sp.P
|
Lamongan
23-08-50
|
|
|
Umum
|
: UNAIR,
1978
|
|
Spesialis
|
: UNAIR, 1991
|
|
Dr
Wahidin 57 - 63 Lamongan |
|
|
|
| 30 |
220 |
DR Dr |
Tahan P
Hutapea Sp.P MARS
 |
Tarutung
06-09-50
|
Kristen
Protestan
|
|
Umum
|
: USU,
1978
|
|
Spesialis
|
: UNAIR, 1991
|
| DR/Prof |
: UNAIR,
2006 |
|
Jemur
Sari Utara V / 7 Surabaya 60285 |
Siloam
Hospital - Surabaya
RS Katolik St. Vincentius A Paulo-Surabaya
RS Darmo - Surabaya |
Dr Ratna
Dewi S, Sp.JP (i)
Patricia Hanna Kartinia, SH, SPsi
Nugraha T. Haudungan, ST
Franky Dfarmawan Immanuel |
Telp 031
- 5942023
HP 0813-30646646 |
| 31 |
222 |
Dr |
Budi
Haryanto Sp.P
 |
06-08-49
|
Kristen
|
|
Umum
|
: UGM,
1977
|
|
Spesialis
|
: UNAIR, 1992
|
|
Agus
Salim 24 Pamekasan 69313 Madura |
RSUD
PamekasanJl. Mandilaras
RS Larasati - Pamekasan
Klinik Jl. Purba 20 - Pamekasan |
Ny. Ruth
Sumaryanti (i)
Deddy Iskandar
Siska Yunita
Silas Kurniawan |
Telp
0324 - 322324
HP 0812-3572327 |
| 32 |
225 |
Dr |
Budi
Lasmono Sp.P
 |
Surabaya
03-04-55
|
Islam
|
|
Umum
|
: UNAIR,
1982
|
|
Spesialis
|
: UNAIR, 1992
|
|
Rungkut
Asri V - 25 Surabaya 60293 |
RS
Bhayangkara Polda Jatim - Surabaya
Klinik Qurota Rungkut Kidiul - Surabaya |
Ny.
Donna Mariana (i)
Merry Lasmananingrum
Rahadian Syahputra |
Telp
031-8796317
HP 012-1603033 |
| 33 |
226 |
Dr |
Rusli
Witono Sp.P
 |
Semarang
08-08-48
|
Islam
|
|
Umum
|
: UNAIR,
1978
|
|
Spesialis
|
: UNAIR, 1992
|
|
Manyar
Indah VI/21 Surabaya |
RSU
Blambangan - Banyuwangi
RS Islam Fatimah - Banyuwangi
RS Yasmin - Banyuwangi |
Ny. Sri
Dewi Riniyanti (i)
Ir. Saddam Mikhael
Retno Ayudiah Arumsari W, SH
Letda. Dibya Sistha Arumadatu |
Telp 031
- 5931989
HP 08123540413 |
| 34 |
246 |
Dr |
Harianto
Tanumihardjo Sp.P
 |
Surabaya
11-09-51
|
Protestan
|
|
Umum
|
:
UNIBRAW, 1980
|
|
Spesialis
|
: UNAIR, 1993
|
|
Imam
Bonjol 131 Surabaya |
Poli
Paru RKZ Jl. Ciliwung Surabaya |
Dra.
Yanti Sutanto (i)
Lawrence Janua, ST
Grace Kumalasari, Sked |
Telp 031
- 5676389
HP 08123564092 |
| 35 |
247 |
Dr |
Daniel
Maranatha Sp.P(K)
 |
Surabaya
23-06-55
|
Protestan
|
|
Umum
|
: UGM ,
1982
|
|
Spesialis
|
: UNAIR, 1993
|
|
Ketintang
Selatan VI / 12 Ketintang Permai RD 18 Surabaya |
RSUD Dr
Soetomo - Surabaya
RS Mitra Keluarga - Surabaya
Praktik Pribadi Jl. Kupang Jaya No.1D Surabaya |
Dr
Elizabeth M. Toar (i)
Rena Arusita
Nisa Aramita
Reza Adipatria |
Telp 031
- 828 3613
HP 0815-5280445 |
| 36 |
249 |
Dr |
Ediyono
Sp.P
 |
Magelang
13-02-55
|
Kristen
|
|
Umum
|
: UGM ,
1980
|
|
Spesialis
|
: UNAIR, 1994
|
|
Kedung
Klinter I/26 Surabaya |
Praktik
Pribadi Jl. Kedung Klinter I/26 Surabaya
RS Medis Pusura - Surabaya
RSAL Dr Ramelan-Surabaya |
Ny. Lily
Susanti (i)
Andrew Suprayogi
Kevin Adrian |
Telp 031
- 5312224
HP 08856-48558888 |
| 37 |
250 |
Dr |
T. Herry
Santosa Sp.P
 |
Tuban
27-03-53
|
Katolik
|
|
Umum
|
: UNAIR,
1980
|
|
Spesialis
|
: UNAIR, 1994
|
|
Imam
Bonjol 8 Surabaya |
RS Budi
Mulya - Surabaya
RS Dharmo - Surabaya |
Lanny
Kartono, SH (i)
Martinus David Santoso
Teresia Aprilia Listiyani |
Telp 031
- 5683487
HP 0812-3534630 |
| 38 |
252 |
Dr |
Yanto
Poernomohadi Sp.P
|
Bojonegoro
|
Protestan
|
|
Umum
|
: UNAIR,
1977
|
|
Spesialis
|
: UNAIR, 1995
|
|
Bintang
Diponggo 805 Surabaya |
RSAL
Ramelan - Surabaya
RS Bakti Rahayu - Surabaya |
Ny. Irma
(i)
Rullyna Dian Fajarrini
Aditya Sandy Purnomo
Shiella Ayu Mediarini |
Telp 031
- 5680449, 5676975
HP 0813-30365554 |
| 39 |
280 |
Dr H |
Endro
Sukmono Sp.P
 |
Pekalongan
03-11-54
|
Islam
|
|
Umum
|
: UNAIR,
1984
|
|
Spesialis
|
: UNAIR, 1994
|
|
Darmo
Baru I / 45 Surabaya |
RS Haji
Sukolilo-Surabaya
RS Siti Khodijah - Surabaya |
Ny. R.A.
Sri Susilaningsih (i)
RR. Febriani Puspitasari
RR. Marina Puspawardani |
Telp 031
- 7315854
HP 0812-3293265 |
| 40 |
284 |
Dr |
Winariani
K, Sp.P(K)
 |
Sampang
13-07-54
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Islam
|
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Umum
|
: UNAIR,
1981
|
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Spesialis
|
: UNAIR, 1994
|
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Imam
Bonjol 21 Surabaya 60264 |
RSUD Dr
Soetomo - Surabaya
RS Graha Amerta - Surabaya
RS Islam Jemur Sari - Surabaya |
Dr
Djiwatmo, Sp.M (s)
Adi Rahmadi Kurniawan
Indra Rakhmadi Nugraha |
Telp 031
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| 41 |
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Edi
Nurtjahjo Sp.P
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Jakarta
10-06-52
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Islam
|
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Umum
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: UNAIR,
1981
|
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Spesialis
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: UNAIR, 1996
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Rotawu
32A Rt 003 Rw. 006 Sumbersari Jember 68121 |
RS Dr
Soebandi - Jember
RS PTPN XII Jember
Praktik Pribadi, Sumberan Ambulu-Jember |
Ny. Sri
Wahyuni (i)
Fitriana Yudita
Yini Yudianti
Triya Yudinia
Anisah Yudiani |
Telp
0331-339760
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| 42 |
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Nurlaeli
S. Indronoto Sp.P
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Pemalang
16-10-54
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Islam
|
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Umum
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: UNAIR,
1981
|
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Spesialis
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: UNAIR, 1995
|
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Sidodadi
Indah IV / 11 Taman Sidoarjo 61257 |
RSUD
Bangil Pasuruan
RS Masyitoh - Bangil Pasuruan
RS Muhammadiyah Lamongan |
Tn.
Wisnu Indrotono (s)
Indro Sanjoto, ST
Indro Sarjono |
Tep 031
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| 43 |
290 |
Dr H |
Soedarsono
Sp.P(K)
 |
Surabaya
23-11-55
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Islam
|
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Umum
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: UNAIR,
1984
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Spesialis
|
: UNAIR, 1994
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Simorejo
XXVIII / 3 Surabaya |
RSUD Dr
Soetomo - Surabaya
RS Islam Jl. Jemur Sari - Surabaya
Apotik Khen Jl. Arjuno 6 - Surabaya |
Ny. A.
Yoesnani (i)
Amelia Tantri A
Arifta Devi A |
Telp 031
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| 44 |
302 |
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Purwanto
Sp.P
|
Madiun
21-03-57
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Islam
|
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Umum
|
: UNAIR,
1983
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Spesialis
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: UNAIR, 1996
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Bedadung
7 (Depan RS Perkebunan) Jember |
RS Paru
- Jember
RS Perkebunan - Jember
RS Bina Sehat - Jember |
Dr
Sulastri Priadi (i)
Putri Kencana, S.Ked
Dian Astuti Pratiwi
Angga Prawira |
Telp
0331-485447
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| 45 |
337 |
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Arief
Hermanto Sp.P
 |
Surabaya
07-09-57
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Islam
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Umum
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: UNAIR,
1984
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Spesialis
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: UNAIR, 1997
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Dr
Soekandar 7 Mojokerto |
RSUD
Mojokerto
RS PTP Gatol - Mojokerto
Apotik Kimia Farma Jl. Gajah Mada No. 62 Mojokerto |
Dr
Setyowati (i)
Arifandi Raditya Wardana
Arifandi Dwi Satyanto Nugroho
Arifandi Angga Prasetiardi |
HP
0812-3568324 |
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339 |
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Mulyadi
Sp.P
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Aceh
Selatan
19-08-62
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Katolik
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Umum
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: UNAIR,
1969
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Spesialis
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: UNAIR, 1997
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Setonogedong
II / 12 Kediri |
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| 47 |
342 |
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Rustam
Effendi Sp.P
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Pontianak
28-06-58
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Katolik
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Umum
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: UNAIR
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Spesialis
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: UNAIR, 1996
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Koblen 9
Surabaya
Rakai Pitakan 4 Jombang |
RSU
Jombang Jatim
Apotik Setia - Jombang
Apotik Jombang - Jombang |
Dr Sri
Wulani Sumargo, Sp.Rad (i)
Tamara Gladysa
Piar Oktavian |
Telp
0321 - 5312170, 8533003
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DR Dr H |
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Zainullah Sp.P
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Bangkalan
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Islam
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Umum
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1988
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Spesialis
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: UNAIR, 1996
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| DR/Prof |
: UNAIR,
2005 |
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A. Yani
19 Lumajang - 67311 |
RSUD Dr
Soetomo - Surabaya
Apotik Teratai Lumajang
Apotik Purnama - Surabaya |
Ariati
Joelianai, S.Psi (i)
Maulana Muhammad Riza
Azmi Zain
Dzikri Zainullah |
Telp
0334 - 883831
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| 49 |
345 |
Dr H |
Asjhar
Sp.P
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Malang
14-10-62
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Islam
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Umum
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: UNAIR,
1988
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Spesialis
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: UNAIR, 1998
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Wahid
Hasjim 53 Genteng Banyuwangi |
RSUD
Genteng Banyuwangi
RS Alhuda - Genteng Banyuwangi |
Ny.
Fairus (i)
Sakinah Annura
Harira |
Telp
0333 - 845068
HP 0812-3260215 |
| 50 |
346 |
Dr |
Budi
Sutedja Sp.P
 |
Surabaya
03-12-63
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Katolik
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Umum
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: UNAIR,
1989
|
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Spesialis
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: UNAIR, 1999
|
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Dr Cipto
53A Bojonegoro 60161 |
Dr R.
Sosodoro Djatikoesoemo - Bojonegoro |
Ir.
Lilek Soerjani (i)
Jeffrey Sutedja |
Telp
0353 - 892727
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| 51 |
347 |
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Supriyadi
Sp.P
 |
Sidoarjo
08-08-58
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Islam
|
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Umum
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: UNAIR,
1986
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Spesialis
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: UNAIR, 1997
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Raya
Tambak Rejo Indah A-5 Waru - Sidoarjo |
RSUD
Moh. Saleh Probolinggo
Praktik Pribadi Jl. Tambak Rejo Indah Sidoarjo
Praktik Pribadi Jl.Panjaitan No. 55 - Probolinggo |
Rr.
Retno Suryandari (i)
Anggie Parameswari
Indra Sukma Tenggara |
Telp 031
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| 52 |
350 |
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Diah
Roesmawati Sp.P
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Surabaya
30-05-63
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Islam
|
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Umum
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: UNAIR,
1988
|
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Spesialis
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: UNAIR, 1997
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Panglima
Sudirman 71 Wlingi - Blitar |
RS Anisa
- Blitar
RS Budi Rahayu Blitar
Praktik Pribadi Jl. Pang. Sudirman 71 Blitar |
Dr Didik
Agus Gunawan, Sp.OG (s)
Vinda Zeilla Hardi Kurnia
Vandi Rahmat Pradktya
Vakri Attala Putra |
Telp
0342 - 694343
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| 53 |
351 |
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Caecilia
F Lusida, Sp.P
 |
Surabaya
13-05-60
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Katolik
|
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Umum
|
: UNAIR,
1986
|
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Spesialis
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: UNAIR, 1997
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Bogowonto
53 Surabaya |
RSU
Gresik Jatim
Praktik Pribadi Jl. Bogowonto 53 Surabaya |
Dr
Mulyawan, Muliawan Queency Putera, Sp.S (s)
Edward Muliawan Putera
Rudolph Muliawan Putera |
Telp 031
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| 54 |
353 |
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Krisbiyanto
Sp.P
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Bangil
23-01-61
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Islam
|
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Umum
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:
UNIBRAW , 1986
|
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Spesialis
|
: UNAIR, 2001
|
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Dr
Soetomo 51 Ponorogo 63419 |
RSUD Dr
Harjono-Ponorogo
Klinik Puspa Husada-Ponorogo
RS Umum Aisyiyah-Ponorogo |
Dra.
Farida Indriani (i)
Adam Afin Maulana
Mikail Athif Muhamad
Yasmin Aliyah Marwa |
Telp
0352-481816
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| 55 |
356 |
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Didik
Purbandiyono Sp.P
 |
Jombang
29-01-58
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Islam
|
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Umum
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: UNAIR
, 1986
|
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Spesialis
|
: UNAIR, 2001
|
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Taman
Pondok Legi II / A-12 Waru Sidoarjo |
RS Ngudi
Waluyo-Kab. Blitar
RS Syuhada - Blitar
Klinik Apotik Ismangil 1 - Blitar |
Dra.
Rahmawati Muvida (i)
Caesar Rozaq Auditiawan
Caesarisma Vidiyanti |
Telp.
031-8541335
HP 08123137484 |
| 56 |
395 |
Dr |
Syahril
Hidayat Sp.P
 |
Sampang
22-06-59
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Islam
|
|
Umum
|
: UNAIR
, 1989
|
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Spesialis
|
: UNAIR
|
|
Imam
Bonjol 25 Kediri |
RSUD
Gambiran - Kediri
RS Ahmad Dahlan - Kediri
Praktik Pribadi Jl. Imam Bonjol 25 Kediri |
Ny. Elok
Rahmawati (i)
Berliantino Muhammad
Emeraldo Muhammad
Syafiro Muhammad |
Telp
0354-695500
HP 0812-3074567 |
| 57 |
396 |
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Bambang
Sadworo Sp.P
|
Madiun
02-12-59
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Islam
|
|
Umum
|
:
UNIBRAW , 1989
|
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Spesialis
|
: UNAIR, 2001
|
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Letjen
Suprapto 47 Kepatihan Tulungagung |
RSU Dr
Iskak - Tulungagung
RSI Orpeha - Tulungagung
Klinik Putra Waspada - Tulungagung |
Tri Esti
Ekowati, SH (i)
Bertania Ekawardhani
Bonita Ratih P
Reza Aditya M |
Telp
0355 - 321701
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| 58 |
398 |
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Helmia
Hasan Sp.P(K)
 |
Yogyakarta
15-11-59
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Islam
|
|
Umum
|
: UNDIP
, 1985
|
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Spesialis
|
: UNAIR, 2001
|
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Rungkut
Asri 75 (RL III A) / 24 Surabaya |
RSUD Dr
Soetomo - Surabaya
RS. Wijaya - Surabaya |
Dr
Yanuar Syam, Sp.B (s)
Arisia Fadila
Muhamad Rizki |
Telp 031
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| 59 |
401 |
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Nur
Indah Sawitri Sp.P
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Surabaya
27-01-65
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Islam
|
|
Umum
|
: UNAIR
, 1990
|
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Spesialis
|
: UNAIR, 2002
|
|
Kintamani
15 Surabaya |
RS Haji
Sukolilo - Surabaya
RS Islam A Yani - Surabaya |
Drs.
Nurul Qomari, Msi (s)
Yoga Pratama
Mirza Mahendra |
Telp
031-8292016
HP 0817-5272144 |
| 60 |
402 |
Dr |
Mei Budi
Prasetyo Sp.P
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Magetan
17-05-61
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Islam
|
|
Umum
|
: UNAIR
, 1991
|
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Spesialis
|
: UNAIR, 2001
|
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Wilis
I/1 Nganjuk 64419 |
RSUD
Nganjuk
RS Islam Jl. Imam Bonjol - Nganjuk |
Dra. Nur
Widyastuti (i)
Bimantoro Widhi Prasetyo
Satria Budi Utomo
Rachmad Setia Budi |
Telp
0358 - 322247
HP 0817325648 |
| 61 |
403 |
Dr |
Muzaijadah
Retno Arimbi Sp.P
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Surabaya
23-10-63
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Islam
|
|
Umum
|
: UNAIR,
1991
|
|
Spesialis
|
: UNAIR, 2002
|
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Jolotundo
Baru II / 23 Surabaya 60131 |
RS Islam
Surabaya
RS Muhammadiyah Gresik
Praktik Pribadi Jl. Pacar kembang 151 Surabaya |
Ir.
Teguh Indrajanu (s)
Nasrullah Noor Indrajanu
Intan Nurani Indrajanu
Rachmatullah Parulian Indrajanu |
Telp 031
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HP 08165438716 |
| 62 |
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Dr |
R. Moh.
Iqbal Adisukarno Sp.P
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Yogyakarta
31-05-61
|
Islam
|
|
Umum
|
: UNAIR,
1998
|
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Spesialis
|
: UNAIR, 2003
|
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Candra
Kirana Real Estate Blok I No. 2 Mojoroto Kodya Kediri |
RSUD
Gambiran - Kediri
RS Bhayangkara - Kediri
Klinik Apotik Kimia Farma-Kediri |
Ny. Dayu
Rachmatiah (i)
Elida Agustinah
Muhammad Saifurrijal |
Telp
0354 - 770706
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| 63 |
405 |
Dr |
Hanto
Wihardjo Sp.P
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Pati
29-03-63
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Protestan
|
|
Umum
|
: UNS ,
1990
|
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Spesialis
|
: UNAIR, 2001
|
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Kerta
Jaya Indah Timur XI / 45 Blok O - 617 Surabaya |
RSJ
Menur - Surabaya
RS Adi Husada Kapasari - Surabaya
Praktik Pribadi Jl. Bendul Merisi 48 Surabaya |
Dr Rr.
Rachmani Setaputri Sp.Rad (i)
Eunike Vania Ch
Phebe Fedora Ch
Yokhebed Janice Ch |
Telp 031
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Fax 031 - 5994279
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| 64 |
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Dr |
Hermawan
CH Sp.P
|
Jombang
12-04-60
|
Islam
|
|
Umum
|
: UNAIR
, 1987
|
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Spesialis
|
: UNAIR, 2003
|
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Flamboyan
7 Pare |
RSU Pare
RS HVA Perkebunan - Pare
RS Amelia - Pare |
Indiari
Prabektijani, S,Sos (i)
Andrea Eka
Narita Putri Ratnasari
Dania Putri Cahyaning Rahayu |
Telp
0354 - 392516
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| 65 |
408 |
Dr |
Dwiraras
Radityawan Sp.P
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Madiun
30-03-61
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Islam
|
|
Umum
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: UNAIR
, 1987
|
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Spesialis
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: UNAIR, 2003
|
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Raya
Gelam 6 Candi Sidoarjo |
RSUD
Sidoarjo
RS Siti Hajar - Sidoarjo
Praktik Pribadi Jl. Raya Gelam 6 Sidoarjo |
Dr Manik
Retno, Sp.M (i)
Puspita Hapsari Siorasmi
Dewinta Enggar Pramesti
Sintha Lungit Ambaringrum |
Telp 031
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| 66 |
410 |
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Atok
Irawan Sp.P
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Sidoarjo
01-05-66
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Islam
|
|
Umum
|
: UNAIR
, 1991
|
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Spesialis
|
: UNAIR, 2000
|
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Pondok
Mutiara Blok K-5 Sidoarjo |
RSUD
Sidoarjo
RS Delta Surya Sidoarjo
Widjaja Asthma Center - Surabaya |
Ny.
Prita Diana Dewi |
Telp 031
- 8969205
HP 0811 - 308970 |
| 67 |
412 |
Dr |
Oktiningsih
Sp.P
 |
Kediri
30-04-65
|
Protestan
|
|
Umum
|
: UNAIR
, 1990
|
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Spesialis
|
: UNAIR, 2001
|
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Raya
Kutorejo Prima Indah 3 - PD 25 Surabaya |
RS Mitra
Keluarga - Surabaya
Praktik Pribadi Jl. Raya Kutorejo Prima Indah |
Dr
Paulus Sugianto, Sp.S(K) (s)
Cindy Cecilia
Julius Albert Sugianto |
Telp 031
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HP 0815-5001395 |
| 68 |
413 |
Dr |
Bambang
Subarno Sp.P
|
Madiun
30-04-65
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Islam
|
|
Umum
|
: UGM ,
1991
|
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Spesialis
|
: UNAIR, 2004
|
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Letjen S
Parman 34 Madiun |
RSU
Madiun |
Ny.
Diananingsih (i)
Raisa Arum Alisaputri
Rafida Sekar Alveolita |
HP
08179302898 |
| 69 |
414 |
Dr |
Sigit
Aprianto , Sp.P
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Malang
24-04-59
|
Islam
|
|
Umum
|
:
UNIBRAW , 1988
|
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Spesialis
|
: UNAIR, 2006
|
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Raya
Kepuh 47, kec. Sukun, Kel. Bandung Rejosari, Malang |
RS Mardi
Waluyo - Blitar
Praktik Pribadi Jl. Veteran 18 - Blitar
RS Budi Rahayu - Blitar |
Dr Emmy
Herawati, Sp.PK (i)
Dana Septian Mahardi
Denny Surya A
Donny Dasagusta |
Telp
0341 - 803143
HP 0812-3233147 |
| 70 |
423 |
Dr |
Kusdiantoro
, Sp.P
|
Madiun
12-07-61
|
Islam
|
|
Umum
|
: UNAIR
, 1989
|
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Spesialis
|
: UNAIR
|
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Gedung
Sroko Gg. IV / 41 Surabaya |
BP4
Karang Tembok |
Khoiriyah
SE (i)
Faiz Izzaturrohman
Salma Kamila Sakinah
Alia Nur Izzah
Muhammad Lukman Hakim
|
Telp 031
- 5455964
HP 0818-312331 |
| 71 |
424 |
Dr |
Jan Arif
Kadarman, Sp.P
|
Bandung
27-04-64
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Protestan
|
|
Umum
|
:
Maranatha , 1991
|
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Spesialis
|
: UNAIR, 2006
|
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Raya
Rungkut Mapan Blok FB - 07 Surabaya |
RSAL
Ilyas - Tarakan
Praktik Pribadi Jl. Diponegoro No. 12 Tarakan |
Dr Rr.
Marina Inggriaty Tjondrowardoyo (i)
Johline Theda
Jeremy Sean |
Telp 031
- 8704969 |
| 72 |
426 |
Dr |
Laksmi
Wulandari Sp.P
 |
Surabaya
16-05-68
|
|
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Umum
|
: UNAIR
, 1993
|
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Spesialis
|
: UNAIR, 2003
|
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Kelintang
Wiyata II / 25 Surabaya |
RSUD Dr
Sotomo - Surabaya
RS Graha Amerta - Surabaya
RS Husada Utama - Surabaya |
Dr Gatot
Soegiarto, Sp.PD (i)
Rahadyan Adi Pradana
Anindya Paramita
Myrna Dianita Savitri |
Telp 031
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HP 08123019591 |
| 73 |
507 |
Dr |
Agus
Hidayat Sp.P
|
Ponorogo
17-08-64
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Islam
|
|
Umum
|
:
UNIBRAW , 1991
|
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Spesialis
|
: UNAIR, 2004
|
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Pahlawan
2 Magetan |
RSU
Sayidiman Magetan |
Eny
Hidayati, Sp.PD (i)
Qosrina Adenita
Hurun Adenita
Rohimah Kusuma Adenita |
Telp
0351-7749767
HP 0813-35410088 |
| 74 |
513 |
Dr |
Farida
Anggraini Soetedjo , Sp.P
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Surabaya
01-05-68
|
Katolik
|
|
Umum
|
: Wijaya
kusuma, 1994
|
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Spesialis
|
: UNAIR, 2006
|
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Parang
Kusuma 4 A Surabaya |
RS
Wijaya Kusuma - Surabaya
RS Adi Husada Jl. Undaan Wetan - Surabaya
RS Adi Husada Jl. Kapasari- Surabaya |
Drs.
Emmanuel Kristijanto, MSC (i)
Johanes Aprilius Falerio
Maria Stephanie Febryana |
Telp 031
- 3523621
HP 0811305478 |
| 75 |
522 |
Dr |
Joko
Minoyo, Sp.P
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Surabaya
29-11-66
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Islam
|
|
Umum
|
: UNAIR
, 1993
|
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Spesialis
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: UNAIR, 2008
|
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Dukuh
Kupang XXXII No. 18 Surabaya |
|
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| 76 |
523 |
Dr |
Wiwik
Kurnia Ilahi, Sp.P
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Kediri
18-09-67
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Islam
|
|
Umum
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:
UNISULA , 1993
|
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Spesialis
|
: UNAIR , 2006
|
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Boteng
Mengganti Gresik |
RS
Gredia - Gresik
RS Rahmi Dewi - Gresik |
Dr Faiz,
Sp.THT (s)
Faizah Chadijah
Faizah Fadhilah
Moch Akbar
Abdul Raouf |
Telp 031
- 7994056
HP 08563022716 |
| 77 |
425 |
Dr |
Ig. H.
Handoko T Sp.P
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Malang
29-07-61
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Katolik
|
|
Umum
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: UNAIR,
1988
|
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Spesialis
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: UNAIR, 2004
|
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Untung
Suropati 86 Surabaya |
RSAL Dr
Ramelan - Surabaya
RS Surabaya Internasional - Surabaya |
Dr Maria
Magdalena Sulistiowati Santosa, Sp.A (i)
Ipan Santosa Tanuwidjaja
Gabriella Tanuwidaja |
Telp 031
- 5676552
HP 0812 - 3536579 |
| 78 |
490 |
Dr |
Afan
Fathur Achmad, Sp.P
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Sidoarjo
28-12-76
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Islam
|
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Umum
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: UNAIR,
2001
|
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Spesialis
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: UNAIR, 2007
|
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Wonorejo
I/4 Surabaya 60263 |
|
Dr
Anawati (i)
Jordy Maulana Ahmad
Nadine Khayyira Azzahra |
Telp 031
- 5477701
HP 0856-3022716 |
| 79 |
492 |
Dr |
Mulyati
Amir, Sp.P
 |
Makassar
21-04-68
|
Islam
|
|
Umum
|
: UNHAS
, 1995
|
|
Spesialis
|
: UNAIR, 2007
|
|
Puri
Bunga Estate Simpang Candi Panggung B/31 Malang |
|
Dr Heri
Sugeng Widodo, MKes (s)
Tegar Nuril Islamy
Lintang Kinasih |
Telp
0341-478213
HP 0858-50170645 |
| 80 |
506 |
Dr |
Susaniwati
Sp.P
 |
Surabaya
10-12-69
|
Katolik
|
|
Umum
|
: UNAIR,
1995
|
|
Spesialis
|
: UNAIR, 2004
|
|
Mulyosari
Timur 36 Surabaya |
RSUD Dr
M Soewandi - Surabaya |
Dr Nario
Gunawan, Sp.OT |
|
| 81 |
510 |
Dr |
Santoso
Sp.P
 |
Kediri
16-05-65
|
Katolik
|
|
Umum
|
: UNS,
1991
|
|
Spesialis
|
: UNAIR, 2005
|
|
Doho 40
Surabaya 60265 |
RS
William Booth - Surabaya
Klinik Medis Usura Rungkut - Surabaya |
Dr Santi
Sadikin
Iris Santoso
Irvin Santoso |
Telp 031
- 8720582
HP 0812-3103786 |
| 82 |
511 |
Dr |
Sajariah
Sp.P
 |
Malang
25-12-64
|
Islam
|
|
Umum
|
:
UNIBRAW, 1989
|
|
Spesialis
|
: UNAIR, 2004
|
|
Bromo
Gg. Kavling 57 Kepanjen Malang 65163 |
RSI
Aisyah - Malang
RS Wasa Husada - Malang |
Ir. R.
Munip (s)
Sulthony Munib |
Telp
0341 - 393707
HP 081330558519 |
