Individual
ILYA A KHOTIMSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
430 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 929-2300
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(929) 926-8340
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
56854
WI
207L00000X
Anesthesiology Physician
56854-20
WI
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
56854-20
WI
Other
Enumeration date
09/08/2009
Last updated
12/30/2021
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