Individual
MICHAEL LEGACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 916-7952
Mailing address
2799 W GRAND BLVD, DETROIT, MI 48202-2689
(313) 916-7952
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
5101026139
MI
2085R0202X
Diagnostic Radiology Physician
Primary
5101026139
MI
Other
Enumeration date
05/07/2016
Last updated
12/06/2021
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