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DR. EDDIE KIYOSHI BROTKOWSKI D.D.S., M.D.
NPI 1003100470
Dentist - Oral and Maxillofacial Surgery in Fond Du Lac, WI

Active since June 02, 2011Opted out of Medicare · through Mar 12, 2028
464 S HICKORY ST STE A, FOND DU LAC, WI 54935(920) 923-0111(920) 923-0366 Get Directions Write a Review

NPPES record last updated: May 6, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Eddie Kiyoshi Brotkowski D.d.s., M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. EDDIE KIYOSHI BROTKOWSKI D.D.S., M.D. (NPI 1003100470) is an individual oral and maxillofacial surgery provider in Fond Du Lac, Wisconsin, licensed in Wisconsin (1001767) and active in the NPI registry since June 2011. He has opted out of Medicare through March 12, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1003100470
Entity TypeIndividualMale
Primary Taxonomy1223S0112X
Provider Legal NameDR. EDDIE KIYOSHI BROTKOWSKICredential: D.D.S., M.D.
Location Address464 S HICKORY ST STE AFond Du Lac, WI 54935-5531
Mailing Address2425 W Kellogg AveWest Peoria, IL 61604-5011 · (847) 612-3407
Phone(920) 923-0111
Fax(920) 923-0366
Sole ProprietorNo
Enumeration DateJune 2, 2011
Last NPPES UpdateMay 6, 2019
✔ NPI 1003100470 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
License✔ Licensed in WI · 1001767
Definition
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
464 S HICKORY ST STE A, Fond Du Lac, WI 54935
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Aspirus Health Plan, BEST Life and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

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Opted out of Medicare

Dr. Eddie Kiyoshi Brotkowski D.d.s., M.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from March 12, 2020 through March 12, 2028.

Opt-Out Effective DateMarch 12, 2020
Opt-Out In Effect ThroughMarch 12, 2028Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 54935 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$82.92 typical visit price
range $53.90 – $163.24
Typical copayment $20.73 (range $13.47 – $40.81)
Most-billed visit code 99203
Established Patient
$67.37 typical visit price
range $17.40 – $133.76
Typical copayment $16.84 (range $4.35 – $33.44)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Eddie Brotkowski's NPI number?

The NPI number for Eddie Brotkowski is 1003100470. It was assigned to this individual provider in the NPPES registry on June 2, 2011.

Where is Eddie Brotkowski located?

Eddie Brotkowski practices at 464 S Hickory St Ste A, Fond Du Lac, WI 54935. The listed phone number is (920) 923-0111.

What is Eddie Brotkowski's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Is Eddie Brotkowski enrolled in Medicare?

No. Eddie Brotkowski has opted out of Medicare through March 12, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

What insurance does Eddie Brotkowski accept?

Health plans from Anthem Blue Cross and Blue Shield, Aspirus Health Plan, BEST Life, Blue Cross and Blue Shield of Alabama and Blue Cross and Blue Shield of Montana and 11 other insurers list Eddie Brotkowski as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Eddie Brotkowski was last updated on May 6, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.