Provider Demographics
NPI:1316159361
Name:LAURAN A. BRYAN, M.D., P.C.
Entity type:Organization
Organization Name:LAURAN A. BRYAN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURAN
Authorized Official - Middle Name:ANTHEA
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-584-0044
Mailing Address - Street 1:26711 WOODWARD AVE
Mailing Address - Street 2:SUITE LL-1
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1333
Mailing Address - Country:US
Mailing Address - Phone:248-584-0044
Mailing Address - Fax:248-584-0056
Practice Address - Street 1:26711 WOODWARD AVE
Practice Address - Street 2:SUITE LL-1
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1333
Practice Address - Country:US
Practice Address - Phone:248-584-0044
Practice Address - Fax:248-584-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010584622086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301058462OtherSTATE MEDICAL LICENSE
MI0632611OtherBCBS OF MI
MIOM42880Medicare ID - Type Unspecified
MIF66121Medicare UPIN