Individual provider Active NPI

Ladan Mostaghimi Tehrani, MD

  • Psychiatry Physician
  • Tomah, WI
National Provider Identifier
1720057920
Registry record updated Jan 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
41718 Issued in WI
Practice address
500 E Veterans St
Tomah, WI 54660-3105
Phone
(608) 872-8662
NPI assigned
Mar 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 41718 WI Primary

Addresses

Primary practice location

500 E Veterans St
Tomah, WI 54660-3105

Mailing address

7433 Elmwood Ave
Middleton, WI 53562-3105
Phone (087) 707-2216

Other practice location 1

1105 E Grand Ave
Rothschild, WI 54474-1024
Phone (800) 872-8662 ext. 43461

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100423000651 WI Practitioner - DermatologyPractitioner - Psychiatry 3870620727 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
41718WIMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Milwaukee Behavioral Health LLC Psychiatry CurrentSince Feb 1, 2022 Accepting new patients
Teladoc Health Medical Group, P.a. Dermatology Current Accepting new patients
Watertown Physician Practices LLC Current Accepting new patients
Watertown Physician Practices LLC CurrentSince Nov 13, 2018 Accepting new patients
Watertown Physician Practices LLC CurrentSince Nov 13, 2018 Accepting new patients

Locations

330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780

123 Hospital Dr
Ste 110
Watertown, WI 53098
Phone (920) 261-0672

1507 Doctors Ct
Watertown, WI 53094
Phone (920) 261-4111

1706 S 68th St
West Allis, WI 53214
Phone (414) 667-4800

Interoperability endpoints

  • Direct secure messaging: ladanmostaghimitehrani@tdh.allscriptsdirect.net

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705449600000",
    "number": "1720057920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7433 ELMWOOD AVE",
            "city": "MIDDLETON",
            "state": "WI",
            "postal_code": "535623105",
            "telephone_number": "087-707-2216",
            "fax_number": "608-827-6960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 E VETERANS ST",
            "city": "TOMAH",
            "state": "WI",
            "postal_code": "546603105",
            "telephone_number": "608-872-8662"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1105 E Grand Ave",
            "address_purpose": "LOCATION",
            "city": "Rothschild",
            "state": "WI",
            "postal_code": "544741024",
            "country_code": "US",
            "telephone_number": "800-872-8662 x43461",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOSTAGHIMI TEHRANI",
        "first_name": "LADAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-17",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WI",
            "license": "41718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tomah, WI

Sources for this page

Verify at the official NPI Registry.