| NPI | 1902023641 |
|---|---|
| Doing Business As | LEGACY MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | BRIAN T GIETZEN Owner Medical Director 248-650-1800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301070159) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2020-10-15 |