Provider Demographics
NPI:1508834458
Name:SOFMAN, MICHAEL SANFORD (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SANFORD
Last Name:SOFMAN
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 1:4340 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021
Mailing Address - Country:US
Mailing Address - Phone:954-983-5533
Mailing Address - Fax:954-983-6694
Practice Address - Street 1:4340 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-983-5533
Practice Address - Fax:954-983-6694
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL54813207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035844400Medicaid
E21809Medicare UPIN
FL035844400Medicaid