Healthcare Provider Details

I. General information

NPI: 1316159361
Provider Name (Legal Business Name): LAURAN A. BRYAN, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26711 WOODWARD AVE SUITE LL-1
HUNTINGTON WOODS MI
48070-1333
US

IV. Provider business mailing address

26711 WOODWARD AVE SUITE LL-1
HUNTINGTON WOODS MI
48070-1333
US

V. Phone/Fax

Practice location:
  • Phone: 248-584-0044
  • Fax: 248-584-0056
Mailing address:
  • Phone: 248-584-0044
  • Fax: 248-584-0056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number4301058462
License Number StateMI

VIII. Authorized Official

Name: DR. LAURAN ANTHEA BRYAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 248-584-0044