Provider Demographics
NPI:1043452139
Name:SOFEN, BRYAN DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:DANIEL
Last Name:SOFEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26400 W 12 MILE RD STE 180
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1785
Mailing Address - Country:US
Mailing Address - Phone:248-355-5047
Mailing Address - Fax:248-355-3511
Practice Address - Street 1:26400 W 12 MILE RD STE 180
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1785
Practice Address - Country:US
Practice Address - Phone:248-355-5047
Practice Address - Fax:248-355-3511
Is Sole Proprietor?:No
Enumeration Date:2009-04-03
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301113046207ND0101X, 207N00000X
NY260224207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery