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Individual provider Active NPI

Daniel E Tackabury, MD

  • Family Medicine Physician
  • North Branch, MI
National Provider Identifier
1104807973
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301070116 Issued in MI
Practice address
3789 Huron St
North Branch, MI 48461-8117
Phone
(810) 688-3093
Fax
(810) 688-3964
NPI assigned
Nov 9, 2005
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301070116 MI Primary

Addresses

Primary practice location

3789 Huron St
North Branch, MI 48461-8117

Mailing address

401 S Ballenger Hwy
Flint, MI 48532-3638
Phone (810) 342-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040519001017 MI Practitioner - Family Practice 4284625203 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wayne State University School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
McLaren Lapeer RegionGroup PAC ID 8123000544, 36 clinicians

Practice addresses (Care Compare)

4482 Huron St
North Branch, MI 48461-8667
Phone (810) 688-3093

809 W Dryden Rd
McLaren Community Medical Center Metamora
Metamora, MI 48445-8961
Phone (810) 678-4000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301070116MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
McLaren Lapeer Region Current Accepting new patients
McLaren Lapeer Region Family Medicine CurrentSince Apr 1, 2012 Accepting new patients
McLaren Thumb Region CurrentSince Mar 1, 2025 Accepting new patients
Huron Pathology Services PC Current Accepting new patients
McLaren Thumb Region Current Accepting new patients
McLaren Thumb Region CurrentSince Mar 1, 2025 Accepting new patients
McLaren Central Michigan Family Medicine CurrentSince Jan 28, 2026 Accepting new patients
McLaren Lapeer Region CurrentSince Apr 1, 2012 Accepting new patients
McLaren Central Michigan CurrentSince Jan 28, 2026 Accepting new patients
McLaren Lapeer Region Past Accepting new patients

Locations

1011 S Van Dyke Rd
Ste C
Bad Axe, MI 48413
Phone (989) 269-5258

1100 S Van Dyke Rd
Bad Axe, MI 48413
Phone (989) 269-9521

7115 Cade Rd
Brown City, MI 48416
Phone (810) 346-2757

1800 W Caro Rd
Ste Viii
Caro, MI 48723
Phone (989) 672-5151

401 S Ballenger Hwy
Flint, MI 48532
Phone (810) 342-1000

1254 N Main St
Lapeer, MI 48446
Phone (810) 664-4531

809 W Dryden Rd
Metamora, MI 48455
Phone (810) 678-4000

1221 South Dr
Mt Pleasant, MI 48858
Phone (989) 772-6700

4482 Huron St
North Branch, MI 48461
Phone (810) 688-3093

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1131494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1104807973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 S BALLENGER HWY",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485323638",
            "telephone_number": "810-342-1000",
            "fax_number": "810-342-1590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3789 HURON ST",
            "city": "NORTH BRANCH",
            "state": "MI",
            "postal_code": "484618117",
            "telephone_number": "810-688-3093",
            "fax_number": "810-688-3964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACKABURY",
        "first_name": "DANIEL",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-09",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301070116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Branch, MI

Sources for this page

Verify at the official NPI Registry.