MEDICARE: LAURAN BRYAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0122X	Plastic and Reconstructive Surgery Physician	4301058462	MI

General Provider Information

NPI Number	:	1972630259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURAN BRYAN MD

Provider Business Mailing Address
First Line	:	27209 LAHSER RD
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48034-8401
Country	:	US
Telephone Number	:	248-356-5815
Fax Number	:	248-356-5830

Provider Business Practice Location Address
First Line	:	26711 WOODWARD AVE STE LL1
Second Line	:
City	:	HUNTINGTON WOODS
State	:	MI
Zip	:	48070-1370
Country	:	US
Telephone Number	:	248-584-0044
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/10/2015

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