Healthcare Provider Details

I. General information

NPI: 1326456674
Provider Name (Legal Business Name): LAUREL ANNE SOFER MD.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREL ANNE GRABAWITZ MD,

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 CORAL RIDGE DR STE 106
CORAL SPRINGS FL
33076-3379
US

IV. Provider business mailing address

3700N LAKE SHORE DR 124
CHICAGO IL
60613-4200
US

V. Phone/Fax

Practice location:
  • Phone: 954-714-8200
  • Fax: 954-840-2626
Mailing address:
  • Phone: 914-907-5158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME143182
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: