Provider Demographics
NPI:1881625028
Name:THANGAM, SABANAYAGAM (MD)
Entity type:Individual
Prefix:
First Name:SABANAYAGAM
Middle Name:
Last Name:THANGAM
Suffix:
Gender:M
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 1997
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33509-1997
Mailing Address - Country:US
Mailing Address - Phone:813-685-2191
Mailing Address - Fax:813-689-8755
Practice Address - Street 1:533 MEDICAL OAKS AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5961
Practice Address - Country:US
Practice Address - Phone:813-295-5800
Practice Address - Fax:813-689-8811
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061427207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370264200Medicaid
FLD94003Medicare UPIN
FL370264200Medicaid