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General NPI Number Information
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NPI Number | 1982855110
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Entity Type | Individual
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Provider Name | MICHELLE SUE LEGACY DO
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Gender | Female
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 1392 S CASS LAKE RD
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City | WATERFORD
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State | MI
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Zip | 48328-4741
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Country | US
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Telephone | 248-338-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 1392 S CASS LAKE RD
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City | WATERFORD
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State | MI
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Zip | 48328-4741
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Country | US
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Telephone | 248-338-6400
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Fax | 248-338-2920
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 5101017676
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MI5101017676
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License Number State | MI
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