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General NPI Number Information
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NPI Number | 1649214099
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Entity Type | Organization
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Legal Business Name | UPPER MICHIGAN CARDIOVASCULAR ASSOCIATES, PC
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 10/06/2008
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Provider Practice Location Address
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Address Line | 1414 WEST FAIR AVE SUITE 334
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City | MARQUETTE
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State | MI
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Zip | 49855
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Country | US
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Telephone | 906-225-3870
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Fax | 906-225-4861
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Provider Business Mailing Address
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Address Line | 1414 WEST FAIR AVE SUITE 334
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City | MARQUETTE
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State | MI
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Zip | 49855
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Country | US
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Telephone | 906-225-3870
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Fax | 906-225-4861
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS DALE LEGALLEY
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Credential | MD
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Telephone | 906-225-3870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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