Organization
LEGACY DERMATOLOGY GROUP PC
Active
Other names
Legacy Dermatology Group
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE SUE LEGACY DO (PRESIDENT)
(248) 338-6400
Entity
Organization
Contact information
Practice address
1392 S CASS LAKE RD, WATERFORD, MI 48328
(248) 338-6400
(248) 338-2920
Mailing address
1392 S CASS LAKE RD, WATERFORD, MI 48328
(248) 338-6400
(248) 338-2920
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
5101017676
MI
Other
Enumeration date
05/03/2016
Last updated
04/30/2020
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