Healthcare Provider Details

I. General information

NPI: 1053576090
Provider Name (Legal Business Name): ALAN R DIMOND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8383 GREENWAY BLVD STE 500
MIDDLETON WI
53562-3529
US

IV. Provider business mailing address

8383 GREENWAY BLVD STE 500
MIDDLETON WI
53562-3529
US

V. Phone/Fax

Practice location:
  • Phone: 608-274-4273
  • Fax: 608-274-5546
Mailing address:
  • Phone: 608-274-0355
  • Fax: 608-274-5546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number54469-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: