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Contact Information

ILYA A KHOTIMSKY, MD
430 E DIVISION ST
FOND DU LAC, WI54935-4560
 Phone: 920-929-2300
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Anesthesiology

207L00000X 79 Physician/Addiction Medicine
 

Critical Care Medicine

207LC0200X 05 Physician/Anesthesiology
Indicates primary specialty

NPI Profile & details for ILYA A KHOTIMSKY · (Male)

NPI Number 1245563329
Status Active
Credentials MD
Entity Individual
Enumeration date 09/08/2009
Last updated 12/30/2021 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • WI License # 56854
  • WI License # 56854-20
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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