Healthcare Provider Details

I. General information

NPI: 1760128755
Provider Name (Legal Business Name): BLUEWATER URGENT CARE CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 07/03/2022
Certification Date: 07/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 POINTE TREMBLE RD
ALGONAC MI
48001-1836
US

IV. Provider business mailing address

2700 POINTE TREMBLE RD
ALGONAC MI
48001-1836
US

V. Phone/Fax

Practice location:
  • Phone: 586-625-0455
  • Fax:
Mailing address:
  • Phone: 810-662-2827
  • Fax: 810-821-7821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. IBRAHIM H DABAJA
Title or Position: PRESIDENT
Credential: PA-C, PHD
Phone: 810-662-2827