Provider Demographics
NPI:1588783385
Name:PLOYSANGAM, TANUSIN (MD)
Entity type:Individual
Prefix:DR
First Name:TANUSIN
Middle Name:
Last Name:PLOYSANGAM
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 1894
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50402-1894
Mailing Address - Country:US
Mailing Address - Phone:641-494-3041
Mailing Address - Fax:641-494-3059
Practice Address - Street 1:1010 4TH ST SW
Practice Address - Street 2:STE 330
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2857
Practice Address - Country:US
Practice Address - Phone:641-424-0402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA37142207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA37142OtherIOWA LICENSE