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Organization

BLUE WATER PRIMARY CARE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. IBRAHIM DABAJA PA-C, PH.D. (CHIEF OPERATING OFFICER)
(810) 363-9337
Entity
Organization

Contact information

Practice address
3953 24TH AVE, FORT GRATIOT, MI 48059-4193
(734) 299-0712
Mailing address
3953 24TH AVE, FORT GRATIOT, MI 48059-4193
(810) 363-9337

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary

Other

Enumeration date
08/28/2025
Last updated
01/28/2026
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