Healthcare Provider Details

I. General information

NPI: 1801004866
Provider Name (Legal Business Name): SOFIA LYFORD-PIKE M.D,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 FRANCE AVE S STE 410
EDINA MN
55435-4538
US

IV. Provider business mailing address

7373 FRANCE AVE S STE 410
EDINA MN
55435-4538
US

V. Phone/Fax

Practice location:
  • Phone: 952-844-0404
  • Fax:
Mailing address:
  • Phone: 952-844-0404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number57436
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number57436
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: