| Legacy Medical Group | |
|
1460 Walton Blvd Suite 200 Rochester Hills MI 48309-1768 | |
| (248) 650-1800 | |
| (248) 650-1856 |
| Full Name | Legacy Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 1460 Walton Blvd, Rochester Hills, Michigan |
| Authorized Official Name and Position | Brian T Gietzen (OWNER MEDICAL DIRECTOR) |
| Authorized Official Contact | 2486501800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Medical Group 1460 Walton Blvd Suite 200 Rochester Hills MI 48309-1768 Ph: (248) 650-1800 | Legacy Medical Group 1460 Walton Blvd Suite 200 Rochester Hills MI 48309-1768 Ph: (248) 650-1800 |
| NPI Number | 1902023641 |
|---|---|
| Provider Enumeration Date | 04/20/2007 |
| Last Update Date | 10/15/2020 |
| Medicare PECOS PAC ID | 0840224564 |
|---|---|
| Medicare Enrollment ID | O20050922000379 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902023641 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 4301070159 (Michigan) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Brian T Gietzen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639154263 PECOS PAC ID: 3274567995 Enrollment ID: I20050923000092 |
| Provider Name | Juan J Rhoades |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851672166 PECOS PAC ID: 0042482622 Enrollment ID: I20111003000545 |
| Provider Name | Ameena Kazi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659688828 PECOS PAC ID: 7315173952 Enrollment ID: I20131204000396 |
| Provider Name | Tiffany L Bassily |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669736153 PECOS PAC ID: 2466766803 Enrollment ID: I20150729010342 |
| Provider Name | Jane Maureen Boruta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881043685 PECOS PAC ID: 1052603388 Enrollment ID: I20160707000828 |
| Provider Name | Lucienne Zenieh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477990851 PECOS PAC ID: 7012291263 Enrollment ID: I20170307000995 |
| Provider Name | Lawrence Holloway |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376920819 PECOS PAC ID: 8224300637 Enrollment ID: I20170821000291 |
| Provider Name | Zachary W Salaysay |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750856480 PECOS PAC ID: 0042564593 Enrollment ID: I20181119003277 |
| Provider Name | Kristin Mcerlean |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689237067 PECOS PAC ID: 0244662781 Enrollment ID: I20191127001226 |
| Provider Name | Mirna Jadan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396368643 PECOS PAC ID: 5294157137 Enrollment ID: I20230530000408 |
Avon Geriatric Care Plc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 595 Barclay Cir, Suite D, Rochester Hills, MI 48307 Phone: 248-852-8421 | |
Arturo Prada, M.d., P.c. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6700 N Rochester Rd, Suite 110, Rochester Hills, MI 48306 Phone: 248-652-1202 | |
Lillian Marzouq, M.d. P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 145 Rochdale Dr S, Suite B, Rochester Hills, MI 48309 Phone: 248-652-1560 Fax: 248-652-1591 | |
Mclaren Nowplusclinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1280 Walton Blvd, Rochester Hills, MI 48307 Phone: 248-453-5173 Fax: 810-600-7720 | |
Rochester Internists, Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2708 S Rochester Road, Rochester Hills, MI 48307 Phone: 248-844-1500 Fax: 248-844-1501 | |
Mazen Sabbaq M.d. P.c. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 75 Barclay Cir Ste 205, Rochester Hills, MI 48307 Phone: 248-651-6430 Fax: 248-650-1382 | |
Bishr Ujayli Md Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1349 S. Rochester Road, Suite 115, Rochester Hills, MI 48307 Phone: 248-759-4852 Fax: 248-299-9860 |