Provider Demographics
NPI:1619179447
Name:LEGALL, MICHELLE EVETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:EVETTE
Last Name:LEGALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:GOBERT
Other - Last Name:LEGALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:18321 W LAKE HOUSTON PKWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-3587
Mailing Address - Country:US
Mailing Address - Phone:281-973-9503
Mailing Address - Fax:281-973-9213
Practice Address - Street 1:18321 W LAKE HOUSTON PKWY
Practice Address - Street 2:SUITE 310
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-3587
Practice Address - Country:US
Practice Address - Phone:281-973-9503
Practice Address - Fax:281-973-9213
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine