Individual
DR. EDDIE KIYOSHI BROTKOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.D.
Contact information
Practice address
464 S HICKORY ST STE A, FOND DU LAC, WI 54935-5531
(920) 923-0111
(920) 923-0366
Mailing address
2425 W KELLOGG AVE, WEST PEORIA, IL 61604-5011
(847) 612-3407
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
1001767
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/02/2011
Last updated
05/06/2019
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