Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Djerrick Cu Tan, MD

Individual provider Diagnostic Radiology Physician · NPI 1124002654

Djerrick Cu Tan, MD is a Diagnostic Radiology in Mequon, Wisconsin. Graduated from Indiana University School of Medicine in 1999, 27 years ago. Practices with Premier Radiology Wisconsin LLC, a 111-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Massachusetts, Rhode Island and Wisconsin.

Years since qualifying
27
Trained at
Indiana University School of Medicine
Licensed in
MA, RI, WI
In the registry since
2005
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

10945 N Port Washington Rd Ste 201
Mequon, WI 53092-5078
Phone: (262) 292-3151
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 211 Park St, Attleboro, MA 02703-3143 — (508) 222-5200
  • 450 Veterans Memorial Pkwy Bldg 2, East Providence, RI 02914-5300 — (401) 435-3041

Specialties & licences

Diagnostic Radiology Physician (primary) Taxonomy 2085R0202X · Licence 47802 (WI)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence 1025471 (MA)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence MD20361 (RI)

Record details

NPI number1124002654
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedNovember 29, 2005
Last updated in NPPESFebruary 23, 2026
Certification dateFebruary 23, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDIAGNOSTIC RADIOLOGY
Medical schoolINDIANA UNIVERSITY SCHOOL OF MEDICINE
Graduated 1999 (27 years in practice)
Group practice Premier Radiology Wisconsin Llc — 111 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations20 on file with Medicare

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