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General NPI Number Information
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NPI Number | 1932118536
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Entity Type | Individual
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Provider Name | DONALD MASSENBURG M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 03/27/2018
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Provider Practice Location Address
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Address Line | 3021 VOYAGER DR
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City | GREEN BAY
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State | WI
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Zip | 54311-8303
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Country | US
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Telephone | 920-496-4700
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Fax | 920-272-1108
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Provider Business Mailing Address
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Address Line | 3860 W OGDEN AVE
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City | CHICAGO
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State | IL
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Zip | 60623-2460
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Country | US
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Telephone | 872-588-3000
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Fax | 872-588-3021
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 61024
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 36115006
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License Number State | IL
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