Individual
THOMAS DALE LEGALLEY
Active
Individual
THOMAS DALE LEGALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
4301038201
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060009221
RAILROAD MEDICARE
—
01
—
0605206331
BLUE CROSS BLUE SHIELD
MI
05
—
1391202
—
MI
05
—
34965800
—
WI
Enumeration date
06/16/2006
Last updated
02/05/2008
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