Healthcare Provider Details

I. General information

NPI: 1063493096
Provider Name (Legal Business Name): BRIAN G SANDLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51189 SHELBY PKWY
SHELBY TWP MI
48315-1786
US

IV. Provider business mailing address

51189 SHELBY PKWY
SHELBY TWP MI
48315-1786
US

V. Phone/Fax

Practice location:
  • Phone: 586-997-9700
  • Fax: 586-997-9738
Mailing address:
  • Phone: 586-997-9700
  • Fax: 586-997-9738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number4301058522
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number4301058522
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: