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General NPI Number Information
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NPI Number | 1184426694
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Entity Type | Individual
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Provider Name | TAKIRAH BOND PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 13450 E 12 MILE RD
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City | WARREN
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State | MI
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Zip | 48088-3671
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Country | US
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Telephone | 586-759-5525
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Fax | 586-759-4022
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Provider Business Mailing Address
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Address Line | 21759 HUNTER CIR N
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City | TAYLOR
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State | MI
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Zip | 48180-6355
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601012933
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License Number State | MI
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