Healthcare Provider Details

I. General information

NPI: 1952279754
Provider Name (Legal Business Name): BONAFIDE CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1158 FORT ST
LINCOLN PARK MI
48146-1840
US

IV. Provider business mailing address

1158 FORT ST
LINCOLN PARK MI
48146-1840
US

V. Phone/Fax

Practice location:
  • Phone: 313-925-3325
  • Fax:
Mailing address:
  • Phone:
  • Fax: 313-925-3325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DIANA EL MASRI
Title or Position: BILLING MANAGER
Credential:
Phone: 248-215-0048