LEGACY DERMATOLOGY GROUP PC (NPI# 1588019053) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588019053 |
| Entity Type | Organization |
| Organization Name | LEGACY DERMATOLOGY GROUP PC |
| Other Organization Name | LEGACY DERMATOLOGY GROUP |
| Practice Address |
1392 S Cass Lake Rd Waterford MI 48328 |
| Practice Telephone | 2483386400 |
| Practice Fax Number | 2483382920 |
| Mailing Telephone | 2483386400 |
| Mailing Fax Number | 2483382920 |
| Enumeration Date | 2016-05-03 |
| Last Update Date | 2020-04-30 |
| Authorized Official Name | MICHELLE SUE LEGACY (PRESIDENT) |
| Authorized Official Telephone | 2483386400 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 5101017676 | MI | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Legacy Dermatology Group | Doing Business As Name - Organization |
| Street Address |
1392 S CASS LAKE RD |
| City | WATERFORD |
| State | MI |
| Zip Code | 48328 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477184125 | Lillian Atty | Pharmacist | 1484 Rivona Dr, Waterford, MI 48328 | 2020-01-31 |
| 1437631850 | Rana Ismail | Pharmacist | 3273 West Huron St, Waterford, MI 48328 | 2018-09-01 |
| 1588181978 | India Dunlap | Social Worker | 279 Summit Dr., Waterford, MI 48328 | 2017-08-25 |
| 1689191280 | Sydney Strandberg | Social Worker | 1145 Parkway, Waterford, MI 48328 | 2017-08-24 |
| 1467982074 | Briana Greenlee | Dietitian, Registered | 3819 Faber Terrace, Waterford, MI 48328 | 2017-06-15 |
| 1922537364 | Lourdes Alzheimer's Special Care | Custodial Care Facility | 2400 Watkins Lake Rd, Waterford, MI 48328 | 2017-06-08 |
| 1013446459 | Lourdes Assisted Living | Assisted Living Facility | 2450 Watkins Lake Rd, Waterford, MI 48328 | 2017-06-08 |
| 1932567989 | Devenia Denise Clayter | Counselor | 255 Summit Dr, Waterford, MI 48328 | 2016-02-05 |
| 1922409739 | Stacey Diggs | Counselor | 250 Elizabeth Lake Road, Biomed Behavorial Healthcare, Waterford, MI 48328 | 2014-09-11 |
| 1538412689 | Kristen Hjelmstad | Social Worker | 955 Campus Drive North, Waterford, MI 48328 | 2012-10-25 |
| Find all providers in zip 48328 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992016117 | Martin Hart, M.d., P.C. | Dermatology | 7561 Highland Rd, Waterford, MI 48327-1405 | 2010-06-23 |
| 1932248317 | Marvin D. Siegel, M.d., P.C. | Dermatology | 1095 W Huron St, Waterford, MI 48328-3735 | 2007-02-05 |
| 1104915875 | Michael Tobin Siegel | Dermatology | 1095 W Huron St, Waterford, MI 48328-3735 | 2006-10-12 |
| 1003905712 | Marvin David Siegel | Dermatology | 1095 W Huron St, Waterford, MI 48328-3735 | 2006-10-12 |
| 1073575304 | Martin Hart | Dermatology | 7561 Highland Rd, Waterford, MI 48327 | 2006-04-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710595616 | Diamond Dermatology, Pllc. | Dermatology | 3206 N Main St, Royal Oak, MI 48073-3424 | 2020-07-16 |
| 1477179174 | Alicia Scopis | Dermatology | 50505 Schoenherr Rd Ste 325, Shelby Township, MI 48315-3142 | 2020-06-18 |
| 1003460874 | Derm Institute of West Michigan Plc | Dermatology | 6750 Kalamazoo Ave, Suites C & D, Grand Rapids, MI 49508 | 2019-07-30 |
| 1770080939 | Emily Rose Davis | Dermatology | 5333 Mcauley Dr Rm 2111, Ypsilanti, MI 48197-1097 | 2018-04-12 |
| 1245744242 | Maureen Cliffel Do Pllc | Dermatology | 26454 Woodward Ave Ste 200, Royal Oak, MI 48067-0969 | 2017-11-29 |
| 1306375365 | Lindsay Christina El Awadi | Dermatology | 50182 Schoenherr Rd, Shelby Twp, MI 48315-3136 | 2017-06-05 |
| 1396278099 | Sasank Konda | Dermatology | 3031 W. Grand Blvd., 8th Floor, Dept. of Dermatology, Detroit, MI 48202 | 2017-04-10 |
| 1790132439 | Saara Kanervikkoaho-crane | Dermatology | 1517 Granger Ave, Ann Arbor, MI 48104-4426 | 2016-05-23 |
| 1679955041 | Luke D Killpack | Dermatology | 5333 Mcauley Dr Rm 5003, Ypsilanti, MI 48197-1020 | 2015-06-22 |
| 1225410756 | Kelsey Louise Lawrence | Dermatology | 849 Health Park Blvd, Grand Blanc, MI 48439-7383 | 2015-06-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.