Provider Demographics
NPI:1659408862
Name:BONNEFIL, PATRICIA LINA (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LINA
Last Name:BONNEFIL
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1683 BRANDYWINE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-1109
Mailing Address - Country:US
Mailing Address - Phone:248-853-6746
Mailing Address - Fax:
Practice Address - Street 1:29829 TELEGRAPH RD
Practice Address - Street 2:SUITE L103
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1330
Practice Address - Country:US
Practice Address - Phone:248-352-9525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010852862085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
H89364Medicare UPIN