Thomas Dale Legalley, MD
Individual provider Active NPI Cardiovascular Disease Physician · Marquette, MI
NPI 1255375614 · NPPES record last updated Feb 5, 2008
Key facts
- NPI
- 1255375614
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- License
- 4301038201 (MI)
- Practice address
- 1414 West Fair Avenue
Suite 334
Marquette, MI 49855 - Phone
- (906) 225-3870
- Fax
- (906) 225-4861
- NPI assigned
- Jun 16, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070326000361 | MI | Practitioner - Cardiovascular Disease (Cardiology) | 8224937735 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301038201 | MI | MD | Cardiovascular Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DLP Marquette Physician Practices Inc | Current |
Accepting new patients | |
| Portage Hospital LLC | Current |
Accepting new patients | |
| DLP Marquette Physician Practices Inc | Current | Accepting new patients | |
| Upper Michigan Cardiovascular Associates, PC | Cardiovascular Disease | Current | Accepting new patients |
| DLP Marquette Physician Practices Inc | Current |
Accepting new patients | |
| Portage Hospital LLC | Current |
Accepting new patients |
Locations
500 Campus Dr
Hancock, MI 49930
Phone (906) 483-1000
894 Campus Dr
Ste B
Hancock, MI 49930
Phone (906) 483-1128
600 Macinnes Dr
Houghton, MI 49931
Phone (906) 483-1818
N10561 Grandview Ln
Ironwood, MI 49938
Phone (906) 932-1500
901 Lakeshore Dr
Ishpeming, MI 49849
Phone (906) 485-2653
205 Osceola St
Laurium, MI 49913
Phone (906) 337-3100
1414 W Fair Ave
Ste 36
Marquette, MI 49855
Phone (906) 225-3864
1414 W Fair Ave
Ste 344
Marquette, MI 49855
Phone (906) 225-3910
850 W Baraga Ave
Ste 20
Marquette, MI 49855
Phone (906) 449-3440
1414 W Fair Ave
Ste 334
Marquette, MI 49855
Phone (906) 225-3870
Interoperability endpoints
- thomas.legalley@mghvi.directbygreenway.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 4301038201 | MI | Yes |
Addresses
Primary practice location
1414 West Fair Avenue
Suite 334
Marquette, MI 49855
Mailing address
1414 West Fair Avenue
Suite 334
Marquette, MI 49855
Phone (906) 225-3870
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 060009221 | Other | RAILROAD MEDICARE | |
| 34965800 | Medicaid | WI | |
| 1391202 | Medicaid | MI | |
| 0605206331 | Other | MI | BLUE CROSS BLUE SHIELD |
Other providers in Marquette, MI
- Claire Elizabeth Leckie
- Abraham Lee
- Heather Ball Lee
- Henry Kai Lee
- Jeon W Lee
- Evan Grant Lehr
- John L Lehtinen
- Lisa Clune Lennon
- Zachary Leonard
- Luke I Leppanen
All providers in Marquette, MI · Cardiovascular Disease Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.