NPIMap

Organization Active NPI

Wyandotte Urgent Care Clinic

  • Urgent Care Clinic/Center
  • Wyandotte, MI
National Provider Identifier
1316467384
Registry record updated Dec 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
WYANDOTTE URGENT CARE CLINIC
Practice address
1768 Ford Ave
Wyandotte, MI 48192-2306
Phone
(313) 377-5758
NPI assigned
Jun 21, 2017
Last updated
Dec 19, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Ibrahim Dabaja, PA-C, PHDNPI 1053592238
Title
Ceo
Phone
(734) 299-0712

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X NU Primary

Addresses

Primary practice location

1768 Ford Ave
Wyandotte, MI 48192-2306

Mailing address

1768 Ford Ave
Wyandotte, MI 48192-2306
Phone (734) 299-0712

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170825001715 MI Part B Supplier - Clinic/Group Practice 4183996150 Receives reassigned benefits from 29 practitioners
Practice locations: Wyandotte, MI

National Provider Directory

National Provider Directory

Locations

3941 24th Ave
Fort Gratiot, MI 48059
Phone (810) 882-9373

1768 Ford Ave
Wyandotte, MI 48192
Phone (313) 377-5758

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 29

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1498003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671408000000",
    "number": "1316467384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1768 FORD AVE",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481922306",
            "telephone_number": "734-299-0712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1768 FORD AVE",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481922306",
            "telephone_number": "313-377-5758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYANDOTTE URGENT CARE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-21",
        "last_updated": "2022-12-19",
        "certification_date": "2022-12-19",
        "status": "A",
        "authorized_official_last_name": "DABAJA",
        "authorized_official_first_name": "IBRAHIM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "734-299-0712",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PA-C, PHD"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyandotte, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.