Organization
LEGACY DERMATOLOGY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURENCE BRADLEY MD (MD/OWNER)
(415) 802-1310
Entity
Organization
Contact information
Practice address
2230 HUNTINGTON DR N, ALGONQUIN, IL 60102-4419
(415) 802-1310
(847) 960-3675
Mailing address
2230 HUNTINGTON DR N, ALGONQUIN, IL 60102-4419
(847) 603-4146
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Enumeration date
12/29/2022
Last updated
05/22/2023
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