MEDICARE: RUBEN NGNITEWE MASSA A MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	4301515674	MI
2	2085R0202X	Diagnostic Radiology Physician	MD228042	OR
3	208D00000X	General Practice Physician	82418-20	WI
4	2085R0202X	Diagnostic Radiology Physician	MD.52956	AL
5	2085R0202X	Diagnostic Radiology Physician	MD29939	ME
6	2085R0202X	Diagnostic Radiology Physician	38889	NH
7	208600000X	Surgery Physician	2020014721	MO
8	2085R0202X	Diagnostic Radiology Physician	8241820	WI
9	2085R0202X	Diagnostic Radiology Physician	01098657A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2020014721	OTHER	MO	MO BOARD OF HEALING ARTS

General Provider Information

NPI Number	:	1003430950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUBEN NGNITEWE MASSA A MD

Provider Business Mailing Address
First Line	:	1281 TWISTED BRANCH WAY
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-9012
Country	:	US
Telephone Number	:	913-980-3405
Fax Number	:

Provider Business Practice Location Address
First Line	:	1281 TWISTED BRANCH WAY
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-9012
Country	:	US
Telephone Number	:	913-980-3405
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2020
Last Update Date	:	02/14/2026

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Directions to “ RUBEN NGNITEWE MASSA A MD” Practice Location

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