Provider Demographics
NPI:1780601567
Name:LEGRIS, MICHAEL J (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:LEGRIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6200 SHINGLE CREEK PKWY
Mailing Address - Street 2:SUITE 260
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2128
Mailing Address - Country:US
Mailing Address - Phone:763-561-5349
Mailing Address - Fax:
Practice Address - Street 1:6601 LYNDALE AVE S
Practice Address - Street 2:SUITE 220
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2477
Practice Address - Country:US
Practice Address - Phone:612-823-8001
Practice Address - Fax:612-823-1010
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2021-03-11
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Provider Licenses
StateLicense IDTaxonomies
MN41665207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN839987OtherAMERICA'S PPO
MNHP28750OtherHEALTHPARTNERS
MN1020250OtherPREFERRED ONE
MN3100020OtherMEDICA
MN123453C028OtherUCARE
WI32571800Medicaid
MN916317400Medicaid
MN02F45LEOtherBCBSMN
MN3100020OtherMEDICA
MN02F45LEOtherBCBSMN
WI32571800Medicaid