Legacy Dermatology Group PC
NPI 1588019053ActiveOrganization· Dermatology· Waterford, MI
Dermatology in Waterford, Michigan, registered in NPPES in May 2016. The authorized official on file is Michelle Sue Legacy, DO, President. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1588019053 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | May 3, 2016 |
| Last updated in NPPES | Apr 30, 2020 |
| Certified by provider | Apr 30, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dermatology Primary | 207N00000X | 5101017676 | MI |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (MI) |
|---|
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