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General NPI Number Information
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NPI Number | 1952279754
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Entity Type | Organization
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Legal Business Name | BONAFIDE CARE PLLC
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Dates
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Enumeration Date | 10/24/2025
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 1158 FORT ST
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City | LINCOLN PARK
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State | MI
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Zip | 48146-1840
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Country | US
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Telephone | 313-925-3325
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Fax |
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Provider Business Mailing Address
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Address Line | 1158 FORT ST
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City | LINCOLN PARK
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State | MI
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Zip | 48146-1840
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Country | US
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Telephone |
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Fax | 313-925-3325
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | DIANA EL MASRI
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Credential |
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Telephone | 248-215-0048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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