Provider Demographics
NPI:1437215001
Name:RIOGA, RATIDZAI (MD)
Entity Type:Individual
Prefix:
First Name:RATIDZAI
Middle Name:
Last Name:RIOGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RATIDZAI
Other - Middle Name:
Other - Last Name:MASUNUNGURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7592 SOLUTION CENTER
Mailing Address - Street 2:#777592
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-7005
Mailing Address - Country:US
Mailing Address - Phone:262-641-3700
Mailing Address - Fax:262-641-3719
Practice Address - Street 1:10625 W NORTH AVE STE 326
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2315
Practice Address - Country:US
Practice Address - Phone:414-771-0500
Practice Address - Fax:414-771-0363
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41265207Q00000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41265OtherSTATE LICENSE