Individual
LUCAS BONAFEDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
33080 UTICA RD STE B, FRASER, MI 48026-2038
(586) 296-7250
(586) 296-0276
Mailing address
33080 UTICA RD STE B, FRASER, MI 48026-2038
(586) 296-7250
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
4301502199
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38-1359063
EMPLOYEE IDENTIFICATION NUMBER
MI
Enumeration date
06/19/2015
Last updated
11/03/2021
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