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NPI Code Detail

MEDICARE: KIRSTI MARIE LEGA RDN

MEDICARE: KIRSTI MARIE LEGA RDN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian86034781MI

General Provider Information

NPI Number : 1871043968
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIRSTI MARIE LEGA RDN
Provider Business Mailing Address
First Line : 41531 GLADE RD
Second Line :
City : CANTON
State : MI
Zip : 48187-3769
Country : US
Telephone Number : 810-429-7789
Fax Number :
Provider Business Practice Location Address
First Line : 1726 HOWARD ST
Second Line :
City : DETROIT
State : MI
Zip : 48216-1921
Country : US
Telephone Number : 313-832-3300
Fax Number : 313-832-3393
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2016
Last Update Date : 10/12/2016

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Directions to “ KIRSTI MARIE LEGA RDN” Practice Location

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