Provider Demographics
NPI:1063493096
Name:SANDLER, BRIAN G (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:G
Last Name:SANDLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:51189 SHELBY PKWY
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-1786
Mailing Address - Country:US
Mailing Address - Phone:586-997-9700
Mailing Address - Fax:586-997-9738
Practice Address - Street 1:51189 SHELBY PKWY
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-1786
Practice Address - Country:US
Practice Address - Phone:586-997-9700
Practice Address - Fax:586-997-9738
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058522207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N99670Medicare PIN
MIG15362Medicare UPIN
MIN99670001Medicare PIN