Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 4301058522 | MI |
N | 207ND0101X | MOHS-Micrographic Surgeon | 4301058522 | MI |
NPI | 1063493096 |
---|---|
Provider Name | Dr. Brian G Sandler |
First Address | Shelby Twp, MI 48315-1786 |
Second Address | Shelby Twp, MI 48315-1786 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 28/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G15362 | (02) | MI |