Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 4301053320 | MI |
NPI | 1083789358 |
---|---|
Provider Name | Dr. Robert Legg |
First Address | Southfield, MI 48075-6501 |
Second Address | Southfield, MI 48075-6501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 15/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F62000 | (02) | MI |