Provider Demographics
NPI:1093766040
Name:LOFMAN, ANDREW MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:MICHAEL
Last Name:LOFMAN
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 1:640 N OLD WOODWARD AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-3881
Mailing Address - Country:US
Mailing Address - Phone:248-540-2100
Mailing Address - Fax:248-540-2200
Practice Address - Street 1:4050 W MAPLE RD STE 201
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-3118
Practice Address - Country:US
Practice Address - Phone:248-540-2100
Practice Address - Fax:248-540-2200
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083297208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2406354242OtherBCBSM
MII54227OtherHAP
MI4899248Medicaid
MIP33440001Medicare ID - Type Unspecified
MI2406354242OtherBCBSM