Provider Demographics
NPI:1750444337
Name:TANGSINTANAPAS, PENPUT (MD)
Entity Type:Individual
Prefix:
First Name:PENPUT
Middle Name:
Last Name:TANGSINTANAPAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1500
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48376-1500
Mailing Address - Country:US
Mailing Address - Phone:248-248-0700
Mailing Address - Fax:248-324-1477
Practice Address - Street 1:1484 STRAITS DR
Practice Address - Street 2:STE 5
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-8718
Practice Address - Country:US
Practice Address - Phone:989-667-8740
Practice Address - Fax:989-667-8745
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI035567207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1546674Medicaid
0732083Medicare ID - Type Unspecified
MI1546674Medicaid