Organization
LEGACY PHYSICIAN GROUP, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN THERESE FEDEWA DR (PRESIDENT)
(517) 913-6711
Entity
Organization
Contact information
Practice address
1540 LAKE LANSING RD, 102, LANSING, MI 48912-3756
(517) 913-3900
Mailing address
1540 LAKE LANSING RD STE 203, LANSING, MI 48912-3757
(517) 913-6711
(517) 913-6712
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
07/28/2006
Last updated
02/18/2025
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