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LEGACY DERMATOLOGY GROUP
NPI 1588019053
Dermatology in Waterford, MI

Active since May 03, 2016CLIA Certified · 2 labs
1392 S CASS LAKE RD, WATERFORD, MI 48328(248) 338-6400(248) 338-2920 Get Directions Write a Review

NPPES record last updated: April 30, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Legacy Dermatology Group NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LEGACY DERMATOLOGY GROUP (NPI 1588019053) is a healthcare organization registered as a dermatology in Waterford, Michigan and active in the NPI registry since May 2016. The organization holds 2 active CLIA laboratory certificates and lists Michelle Sue Legacy, President, as its authorized official.

NPPES Registry Identity

NPI1588019053
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameLEGACY DERMATOLOGY GROUP PC
Location Address1392 S CASS LAKE RDWaterford, MI 48328
Mailing Address1392 S Cass Lake RdWaterford, MI 48328 · (248) 338-6400 · Fax (248) 338-2920
Phone(248) 338-6400
Fax(248) 338-2920
Organization SubpartNo
Authorized OfficialMichelle Sue LegacyPresident · (248) 338-6400
Enumeration DateMay 3, 2016
Last NPPES UpdateApril 30, 2020
NPPES CertifiedApril 30, 2020
✔ NPI 1588019053 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License✔ Licensed in MI · 5101017676
Definition
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.
1392 S CASS LAKE RD, Waterford, MI 48328
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Other Names 1

Doing Business AsLegacy Dermatology Group

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 23D0871372

Legacy Dermatology Group · Waterford, MI
Active · expires Apr 11, 2027
CLIA Number23D0871372
Laboratory TypePhysician Office
Certificate Effective DateApril 12, 2025
Certificate Expiration DateApril 11, 2027
Laboratory DirectorMichelle S. Legacy
Laboratory Phone(248) 338-6400
Laboratory LocationLegacy Dermatology Group1392 S Cass Lake Road, Waterford, MI 48328
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Compliance 23D2329300

Legacy Dermatology Group · Highland, MI
Active · expires Aug 25, 2027
CLIA Number23D2329300
Laboratory TypePhysician Office
Certificate Effective DateAugust 26, 2025
Certificate Expiration DateAugust 25, 2027
Laboratory DirectorMichelle S. Legacy
Laboratory Phone(248) 338-6400
Laboratory LocationLegacy Dermatology Group2817 S Milford Road Suite 101, Highland, MI 48357
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ARIA GILLIAN SAVANNAH TRAGER DO
Dermatology
1392 S CASS LAKE RD
WATERFORD, MI 48328
Oakland County (248) 338-6400
DR. MICHELLE SUE LEGACY DO
Dermatology
1392 S CASS LAKE RD
WATERFORD, MI 48328
Oakland County (248) 338-6400

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Legacy Dermatology Group PC's NPI number?

The NPI number for Legacy Dermatology Group PC is 1588019053. It was assigned to this organization in the NPPES registry on May 3, 2016. The provider is doing business as Legacy Dermatology Group.

Where is Legacy Dermatology Group PC located?

Legacy Dermatology Group PC is located at 1392 S Cass Lake Rd, Waterford, MI 48328. The listed phone number is (248) 338-6400.

What is Legacy Dermatology Group PC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Does Legacy Dermatology Group PC hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Legacy Dermatology Group PC accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company list Legacy Dermatology Group PC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Legacy Dermatology Group PC was last updated on April 30, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.