Anggota PDPI cabang Jawa Timur

No. MDSp- Lulus Dokter Lulus Spesialis

No Tempat
Nama IDI
NPA

12-01-
055 Prof. Adji Widjaja, dr., Sp.P(K) 1240 Surabaya UNAIR 10-04-65 UNAIR 71
06-02-37

14-04-
056 Prof. Dr. Thomas 2770 Nganjuk UNAIR 31-01-66 UNAIR 71
V.M. Kardjito, dr., Sp. P(K) 16-07-38

1982/2716/15 18-04-
060 H. Abdul Mukty, dr., Sp.P(K) 5/ Surabaya UNAIR 23-08-65 UNAIR 75
XIV-155 19-11-35

09-02-
065 Prof. Dr. Benjamin 2769 Surabaya UNAIR 29-05-71 UNAIR 76
P Margono, dr., Sp. P(K) 19-11-35

(Meninggal)

06-12-
068 Sahim Rusdiah, dr., Sp.P 955 Pasuruan UNAIR 30-07-60 UNAIR 67
23-05-29

069 Slamet Hariadi, dr., Sp.P(K) 22-09-46

 1983/3053/48 27-10-
070 Prof. Dr. Muhammad 2/ Gresik UNAIR 21-07-73 UNAIR 78
Amin, dr., Sp.P(K) XIV-482 10-08-47

1982/2709/14 02-12-
071 H Samsul Harun 8/ Probolinggo UNAIR 07-04-66 UNAIR 79
Alrasjid, dr., Sp.P(K) XIV-148 07-04-36

16-06-
073 M Yusuf Wibisono, dr., 073 Boyolali UNAIR 22-12-73 UNAIR 79
Sp.P(K), FCCP 02-01-47

1982/2711/15 11-08-
075 Sumarno, dr., Sp.P(K) 6/ Buyaran UI 14-09-65 USU 78
XIV-156 Demai
01-10-39

18-05-
078 Achmad Muchidin 2772 Probolinggo UNAIR 1968 UNAIR 82
Razak, dr., Sp.P 18-08-41

1985/3504/07 06-02-
164 Dr. Justinus Frans Palilingan, dr., 8/ Surabaya UNAIR 23-12-67 UNAIR 84
Sp.P(K) XIV-078 06-10-44
 11-09-
168 Kemas M. Adil, dr., Sp.P(K) 03-04-45 UNAIR 1972 UNAIR 86

UNBRA 11-09-
171 Indra Pinarta, dr., Sp.P 1987/3954/ Bojonegoro W 30-10-76 UNAIR 86
XIV/154 26-04-45

06-11-
188 Sri Prihatini 1987/3813/ Yogyakarta UGM 09-12-70 UNAIR 86
Boestan, dr., Sp.P(K) 08/XIV-08 2605-45

23-08-
195 Kasdi Soepadmo, dr., Sp.P 1991/4348/ Lumajang UNAIR 15-07-76 UNAIR 90
XIV-046 31-0547

05-05-
211 Donny Irawan, dr., Sp.P 1999/4349/ Surabaya Udayana 29-07-78 UNAIR 90
XIV-047 28-11-81

213 H Sofyan Hasan Labuhan USU 1981 UNAIR 1991

Siregar, dr., Sp.P Bilik
27-07-47

27-06-
217 Isnu Pradjoko, dr., Sp.P(K) 1996/4694/ Blitar UNAIR 08-09-77 UNAIR 91
XII-009 22-08-50
 13-06-
220 Dr. Tahan P Hutapea, dr., 1992/4465/ Tarutung USU 16-09-78 UNAIR 91
Sp.P, MARS XIV-079 06-09-50

13-01-
222 Budi Haryanto, dr., Sp.P 06-08-49 UGM 1977 UNAIR 92

27-06-
225 Budi Lasmono, dr., Sp.P 1995/4617/ Surabaya UNAIR 08-09-82 UNAIR 92
VIV-025 03-04-55

27-02-
226 Rusli Witono, dr., Sp.P 1995/4615/ Semarang UNAIR 27-04-78 UNAIR 92
XIV-023 08-08-48

UNBRA 27-04-
246 Harianto 1995/4679/ Surabaya W 04-10-80 UNAIR 93
Tanumihardjo, dr., Sp.P XII-087 11-09-51

04-02-
247 Dr. Daniel 1945/4619/ Surabaya UGM 30-12-82 UNAIR 93
Maranatha, dr., Sp.P(K) XIV027 23-06-55
 20-04-
249 Ediyono, dr., Sp.P 1995/4618/ Magelang UGM 29-03-80 UNAIR 94
XIV-026 13-02-55

20-04-
250 T. Herry Santosa, dr., Sp.P 1995/4681/ Tuban UNAIR 27-11-80 UNAIR 94
XII-089 27-03-53

18-02-
252 Yanto Poernomohadi, dr., Sp.P 1995/4680/ Bojonegoro UNAIR 19-12-77 UNAIR 95
XIV-088

09-08-
280 H. Endro Sukmono, dr., Sp.P 1995/4614/ Pekalongan UNAIR 23-08-84 UNAIR 94
XIV-022 03-11-54

22-08-
284 Winariani Koesoemoprodjo, 1995/4678/ Sampang UNAIR 24-12-81 UNAIR 94
dr., Sp.P(K), MARS., FCCP XII-086 13-07-54
 12-08-
287 Edi Nurtjahja, dr., Sp.P Jakarta UNAIR 1981 UNAIR 96
10-06-52

19-01-
288 Nurlaeli Supartini 1996/4695/ Pemalang UNAIR 12-02-81 UNAIR 95
Indronoto, dr., Sp.P 16-10-54

24-10-
290 Dr. Soedarsono, dr., Sp.P(K) 1996/4713/ Surabaya UNAIR 26-01-84 UNAIR 94
XII-028 23-11-55

UNIBRA 15-08-
300 Moch. Zainun, dr., SpP Surabaya W 1984 UNAIR 96
26-03-55

10-01-
302 Purwanto, dr., Sp.P 1996/4714/ Madiun UNAIR 03-04-83 UNAIR 96
XII-029 21-03-57

23-06-
337 Arief Hermanto, dr., Sp.P Surabaya UNAIR 1984 UNAIR 97
07-09-57
 29-08-
342 Rustam Effendi, dr., Sp.P Pontianak UNAIR 1988 UNAIR 96
28-06-58

12-12-
343 Dr. H. Ahmad Zainullah, dr., Bangkalan UNAIR 07-07-88 UNAIR 96
Sp.P 07-10-61

10-02-
346 Budi Sutedja, dr., Sp.P Surabaya UNAIR 19-01-89 UNAIR 99
03-12-63

347 Supriyadi, dr., Sp.P Sidoarjo UNAIR 30-01-86 UNAIR 1997

08-0858

01-11-
350 Diah Roesmawati, dr., Sp.P Surabaya UNAIR 1988 UNAIR 97
30-05-63

23-06-
351 Caecilia F Lusida, dr., Sp.P Surabaya UNAIR 1986 UNAIR 97
 13-05-60

UNBRA 01-05-
353 Krisbiyanto, dr., Sp.P Bangil W 22-10-86 UNAIR 01
23-01-61

01-05-
356 Didik Purbandiyono, dr., Sp.P Jombang UNAIR 20-02-86 UNAIR 01
29-01-58

UNBRA 15-04-
357 Suhartadi, dr., Sp.P Blitar W 1987 UNAIR 03
19-10-59

15-04-
395 Syahril Hidayat, dr., Sp.P Sampang UNAIR 01-03-89z UNAIR 03
22-06-59

UNBRA 01-05-
396 Bambang Madiun W 1989 UNAIR 01
Sadworo, dr., Sp.P 02-12-59

398 Helmia Hasan, dr., Sp.P(K), Yogyakarta UNDIP 1985 UNAIR 2001
M.Pd.Ked, FCCP 15-11-59
401 Nur Indah Sawitri, dr., Sp.P Surabaya UNAIR 1990 UNAIR 2000
27-01-65

402 Mei Budi Magetan UNAIR 1991 UNAIR 2001

Prasetyo, dr., Sp.P 17-05-61

403 Dr. Muzaijadah Retno Surabaya UNAIR 1991 UNAIR 2002

Arimbi, dr., Sp.P 23-10-63

404 R. Moh. Iqbal Yogyakarta UNAIR 1998 UNAIR 2003

Adisukarno, dr., Sp.P 31-05-61

405 Hanto Wihardjo, dr., Sp.P Pati UNS 1990 UNAIR 2001
29-03-63

407 Hermawan Chrisdiono, dr., Sp.P Jombang UNAIR 1987 UNAIR 2003
12-04-60

408 Dwiraras Radityawan, dr., Sp.P Madiun UNAIR 1987 UNAIR 2003
30-03-61
 UNBRA 18-01-
409 Tetra Agung Wahono, dr., Sp.P Sumenep W 1991 UNAIR 06
19-04-64

410 Atok Irawan, dr., Sp.P Sidoarjo UNAIR 1991 UNAIR 2000
01-05-66

412 Oktiningsih, dr., Sp.P Kediri UNAIR 1990 UNAIR 2001

30-04-65

413 Bambang Subarno, dr., Sp.P Madiun UGM 07-91 UNAIR 2004
30-04-65

UNBRA 18-01-
414 Sigit Aprianto, dr., Sp.P Malang W 00-12-88 UNAIR 06
24-04-59

423 Kusdiantoro ,dr., Sp.P Madiun UNAIR 00-01-89 UNAIR 2007

12-07-61

424 Jan Arif Kadarman, dr., Sp.P Bandung Mara- 09-11-91 UNAIR 2007
27-04-64 natha
425 Ignatius. Hanny Handoko Malang UNAIR 31-03-88 UNAIR 2004
Tanuwijaya, dr., Sp.P 29-07-61

15-04-
426 Dr. Laksmi Wulandari Surabaya UNAIR 14-07-93 UNAIR 03
, dr., Sp.P(K), FCCP 16-05-68

27-07-
490 Affan Fatkhur Ahmad, dr., Sp.P Sidoarjo UNAIR 31-12-01 UNAIR 07
28-12-76

27-07-
492 Mulyati Amir, dr., Sp.P Makassar UNHAS 1995 UNAIR 07
21-04-68

11-07-
496 Resti Yudhawati Cimahi UNAIR 28-01-02 UNAIR 09
Meliana, dr., Sp.P(K) 06-12-76

31-12-
498 Ririek Parwitasari, dr., Sp.P Jakarta UNAIR 19-10-95 UNAIR 08
10-08-68

499 Ganis Tjahyono, dr., Sp.P Surabaya UNAIR 11-03-93 UNAIR 2010
22-01-68
506 Susaniwati, dr., Sp.P Surabaya UNAIR 00-03-95 UNAIR 2004
10-12-69

UNBRA
507 Agus Hidayat, dr., Sp.P Ponorogo W 1991 UNAIR 2004
17-08-64

UDAYA
509 Judyanto Tjahjo Santoso, dr., SpP Surabaya NA 1995 UNAIR 2004
02-03-1970

510 Santoso, dr., Sp.P Kediri UNS 1991 UNAIR 2005

16-05-65

513 Dr. Farida Anggraini Surabaya Wijaya - 1994 UNAIR 2006

Soetedjo , dr., Sp.P 01-05-68 Kusuma

9-6-
517 Bambang Susilo Malang Udayana 1991 UNAIR 2006
Simon , dr., Sp.P 11-12-63

19-04-
523 Wiwik Kurnia Ilahi, dr., Sp.P Kediri Unisula 00-01-93 UNAIR 06
18-09-67
 18-07-
530 Budi Santosa, dr., Sp.P Purbalingga UNDIP 07-97 UNAIR 10
06-10-71

31-12-
531 Christina, dr., Sp.P Malang Udayana 1996 UNAIR 08
07-03-69

534 Agung Kristyono, dr., Sp.P

03-01-
535 Hamida, dr., Sp.P Kediri Hangtuah 01-03 UNAIR 10
26-03-76

581 Syaiful Hidayat, dr., Sp.P Madura UI 06-06-00 UI 2010

10-01-74

701 Isnin Anang Marhana, dr., Sp.P(K), Surabaya UNAIR Des 03 UNAIR 2010
FCCP. 07-11-78

702 Arief Bakhtiar, dr., Sp.P Surabaya UNAIR 2003 UNAIR 2011
22-10-78
 03-01-
703 Tutik Kusmiati, dr., Sp.P(K) Tulung- UNAIR 19-01-00 UNAIR 10
agung
11-04-75

Des
705 Sri Sarwosih Indah Surakarta UNDIP 25-03-96 UNAIR 2011
Marthaty, dr., Sp.P 18-03-69

Des
706 Fitri Sriyani, dr., Sp.P Kediri Udayana 13-02-95 UNAIR 2011
11-12-70

Juli
707 Prastuti Surabaya UNAIR 2003 UNAIR 2012
Astawulaningrum, dr., Sp.P 17-08-78

09-01-
709 Movita Hidayati, dr., Sp.P Jember UNAIR 36896 UNAIR 11
12-08-75

Juni
712 Anna Febriani, dr., Sp.P Palembang UNS 1997 UNAIR 2013
09-02-71

715 Mifta Khussurur, dr., Sp.P Boyolali UNS 08-10-94 UNAIR Juli
 2012
27-07-69

Juli
717 Aisyah Ramadona Surabaya UNAIR 22-12-05 UNAIR 2013
Retnowulan, dr., Sp.P 13-08-79

719 Indrayani, dr., Sp.P Bali Udayana 1995 UNAIR Jan 2013
21-11-69

Juni
720 Wiwin Is Effendi, dr., Sp.P Lamongan UNAIR 2002 UNAIR 2013
13-03-78

Des
721 Sri Rejeki Andayani, dr., Sp.P Kediri UNAIR Des-97 UNAIR 2011
09-03-72

723 Mohamad Arfi, dr., Sp.P Jakarta UNAIR 10-10-01 UNAIR Jan 2013
28-06-73

HANGT
724 Krisna Indrawanto, dr., Sp.P Medan UAH 30-07-03 UNAIR Jan 2013
26-10-75

728 Tjipto Wibowo, dr., Sp.P Merauke Udayana Jan-98 UNAIR 2009
30-05-69

794 Samsuri, dr., Sp.P Jombang UNIBRA 1999 UNAIR

 W
02-03-71

814 Haris Abdullah, dr., Sp.P Klaten UGM 28-10-99 UI Jan 2013
22-04-73

248 Cleimens Manyakori, dr., Sp.P

15 Desember
491 Agus Suharto Basuki, dr., Sp.P 1971

536 Taufik, dr., Sp.P

1111 Anton Hariadi, dr., SpP

828 Asep Tri Handoko, dr., Sp.P Surabaya UNAIR 2002 UNAIR
20-09-75

UNSYIA
829 Budiyanti, dr., Sp.P Lhokseumawe H 2007 UNAIR
29-09-81

832 Dedy Sasongko, dr., Sp.P Kediri UNAIR 1999 UNAIR Jan 2015
20-02-74

Juni
875 Yus Priyatna Surabaya UGM 2004 UNAIR 2014
Adryanto, dr., Sp.P 10-02-77 Yogyakar
 ta

877 Nur Aisah Wardani, dr., Sp.P Pamekasan UNDIP 1999 UNAIR Jun-14
27-01-75 Semarang

UNIBRA
878 Andri Eko Purnomo, dr., Sp.P Bangkalan W 2000 UNAIR Jun-14
31-08-74

880 Mohammad Subkhan, dr., Sp.P Sidoarjo UNAIR 1994 UNAIR Jan 2015
16-06-74

UNIBRA
881 Miftahul Arifin, dr., Sp.P Gresik W 2001 UNAIR Jan 2015
12-10-73

Hang
883 Aries Subianto, d.r, Sp.P Surabaya Tuah 1999 UNAIR
27-08-72

920 Ahmad Nurdin, dr., Sp.P Gresik UNHAS 2002 UNAIR Jan 2015
28-09-75

921 Nurlela Damayanti, dr., Sp.P Jombang UNAIR 17-11-99 UNAIR

25-05-74

922 Abdulloh Najich, dr, Sp.P Surabaya UNAIR 2001 UNAIR

21-04-75
923 Detty Rahmawati, dr, Sp.P Surabaya UNAIR 2006 UNAIR
18-12-80

Jun
Tegal
943 Royani Nurrohman, dr., Sp.P UNS 2008 UI 2014
12-09-83

954 Catur Budi Keswardiono, dr., Sp.P Kediri UNAIR UNAIR

04-07-72

955 Khrisma Wijayanti, dr., Sp.P Purworejo UNS 2001 UNAIR

15-01-77

956 Anik Purnawati, dr, Sp.P Tulungagung UANIR 2003 UNAIR

28-03-77

959 Yuniasri Puspito Rini, dr., Sp.P Surabaya UNAIR 2002 UNAIR
06-03-77

UNIBRA
960 Pramanindyah Bekti Surabaya W 2001 UNAIR
Anjani, dr., Sp.P 23-04-77

961 Rachmad Subagyo, dr., Sp.P Surabaya UNAIR 2001 UNAIR

02-02-77

1002 Adyan Donastin, dr., Sp.P Surabaya UNAIR 2001 UNAIR

29-09-74
 Juni
1005 Irmi Syafa'ah, dr., Sp.P Surabaya UNAIR 2009 UNAIR 2016
05-02-1986

Juni
1003 Farah Fatma Wati, dr., Sp.P Gresik UNAIR 2004 UNAIR 2016
25-06-80

Juni
1008 Anik Sukmawati, dr., Sp.P Jember UNHAS 2005 UNAIR 2016
25-09-80

Juni
1009 Retna Dwi Puspitarini, dr, Sp.P Banyuwangi Udayana 2005 UNAIR 2016
03-11-81

Juni
1014 Elizabeth Vania Palilingan, dr., Sp.P Surabaya UNAIR UNAIR 2016

Juni
Prayudi Tetanto, dr., Sp.P Surabaya UNAIR 2016
07 Oktober 1984

TRISAK
Ariani Permatasari, dr., Sp.P Jakarta TI 2004 UNAIR 2014
27 Januari 1979

1007 Trisasongko Budi Satrio, dr., Sp.P Ujung UNAIR 2004 UNAIR
Pandang
 1 Maret 1980

1010 Alfian Nur Rosyid, dr., Sp.P Surabaya UNAIR 2006 UNAIR
29-03-82

Titin Sholihah Agustina, dr., Sp.P Sidoarjo

23 Agustus 1978

Sari Mandayani, dr., Sp.P Madiun

9 September
1975

Olivia Benedick S.R. Panggabean, dr.,

872
SpP

1000 Fadlia Yulistiana, dr., SpP., M.Kes