Provider Demographics
NPI:1760128755
Name:BLUEWATER URGENT CARE CLINIC PLLC
Entity Type:Organization
Organization Name:BLUEWATER URGENT CARE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:H
Authorized Official - Last Name:DABAJA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C, PHD
Authorized Official - Phone:810-662-2827
Mailing Address - Street 1:2700 POINTE TREMBLE RD
Mailing Address - Street 2:
Mailing Address - City:ALGONAC
Mailing Address - State:MI
Mailing Address - Zip Code:48001-1836
Mailing Address - Country:US
Mailing Address - Phone:810-662-2827
Mailing Address - Fax:810-821-7821
Practice Address - Street 1:2700 POINTE TREMBLE RD
Practice Address - Street 2:
Practice Address - City:ALGONAC
Practice Address - State:MI
Practice Address - Zip Code:48001-1836
Practice Address - Country:US
Practice Address - Phone:586-625-0455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty