Individual
DR. DMITRY K PASIKHOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
146 E GENEVA SQUARE, LAKE GENEVA, WI 53147
(262) 249-5000
(262) 249-7142
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(414) 321-2255
(414) 671-8860
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
36100851
IL
208600000X
Surgery Physician
Primary
44347
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34192400
—
WI
Enumeration date
08/23/2006
Last updated
10/19/2023
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