Organization
BLUE WATER PAIN SPECIALISTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BASSAM E. DURGHAM MD (TREASURER)
(248) 792-7029
Entity
Organization
Contact information
Practice address
22101 MOROSS RD, DETROIT, MI 48236-2148
(313) 343-4000
Mailing address
538 CHASE LN, BLOOMFIELD HILLS, MI 48304-2363
(248) 792-7029
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
—
—
Other
Enumeration date
03/28/2014
Last updated
11/15/2017
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