Provider Demographics
NPI:1982855110
Name:LEGACY, MICHELLE SUE (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:SUE
Last Name:LEGACY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1900 S TELEGRAPH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302
Mailing Address - Country:US
Mailing Address - Phone:248-338-6400
Mailing Address - Fax:248-338-2920
Practice Address - Street 1:1900 S TELEGRAPH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302
Practice Address - Country:US
Practice Address - Phone:248-338-6400
Practice Address - Fax:248-338-2920
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017676207N00000X
MIMI5101017676207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology