Healthcare Provider Details

I. General information

NPI: 1275160244
Provider Name (Legal Business Name): MOHAMADMOSTAFA JAHANSOUZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 CATHEDRAL DR
RAPID CITY SD
57701-6018
US

IV. Provider business mailing address

677 CATHEDRAL DR
RAPID CITY SD
57701-6018
US

V. Phone/Fax

Practice location:
  • Phone: 605-755-5000
  • Fax:
Mailing address:
  • Phone: 605-755-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number00016637
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number00016637
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: