Organization
LEGACY DERMATOLOGY GROUP PC
Active
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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