Healthcare Provider Details

I. General information

NPI: 1437215001
Provider Name (Legal Business Name): RATIDZAI RIOGA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RATIDZAI MASUNUNGURE MD

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10625 W NORTH AVE STE 326
WAUWATOSA WI
53226-2315
US

IV. Provider business mailing address

7592 SOLUTION CENTER #777592
CHICAGO IL
60677-7005
US

V. Phone/Fax

Practice location:
  • Phone: 414-771-0500
  • Fax: 414-771-0363
Mailing address:
  • Phone: 262-641-3700
  • Fax: 262-641-3719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number41265
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number41265
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: