Provider Demographics
NPI:1134768179
Name:LEGACY INTERNAL MEDICINE, PLLC
Entity type:Organization
Organization Name:LEGACY INTERNAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UROOJ
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-414-9540
Mailing Address - Street 1:11330 LEGACY DR STE 204
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-1206
Mailing Address - Country:US
Mailing Address - Phone:469-731-4200
Mailing Address - Fax:469-731-4300
Practice Address - Street 1:11330 LEGACY DR STE 204
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-1206
Practice Address - Country:US
Practice Address - Phone:469-731-4200
Practice Address - Fax:469-731-4300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-21
Last Update Date:2019-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty