Healthcare Provider Details

I. General information

NPI: 1003430950
Provider Name (Legal Business Name): RUBEN NGNITEWE MASSA A MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1281 TWISTED BRANCH WAY
SUN PRAIRIE WI
53590-9012
US

IV. Provider business mailing address

1281 TWISTED BRANCH WAY
SUN PRAIRIE WI
53590-9012
US

V. Phone/Fax

Practice location:
  • Phone: 913-980-3405
  • Fax:
Mailing address:
  • Phone: 913-980-3405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number46990
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number38889
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01098657A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number110894
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number8241820
License Number StateWI
# 6
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301515674
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD228042
License Number StateOR
# 8
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD29939
License Number StateME
# 9
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD.52956
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: