Organization
UPPER MICHIGAN CARDIOVASCULAR ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS DALE LEGALLEY MD (PRESIDENT)
(906) 225-3870
Entity
Organization
Contact information
Practice address
1414 WEST FAIR AVE, SUITE 334, MARQUETTE, MI 49855
(906) 225-3870
(906) 225-4861
Mailing address
1414 WEST FAIR AVE, SUITE 334, MARQUETTE, MI 49855
(906) 225-3870
(906) 225-4861
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
700E210530
BLUE CROSS BLUE SHIELD
MI
Enumeration date
06/16/2006
Last updated
10/06/2008
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