Active NPI
Kenneth Eugene Dambacher, D.O.
- Family Medicine Physician
- Peck, MI
National Provider Identifier
1194701946
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 5101008768
- Practice address
- 251 E Peck Rd
Peck, MI 48466-9589 - Phone
- (810) 378-4900
- Fax
- (810) 378-4905
- NPI assigned
- Dec 22, 2005
- Last updated
- Jul 13, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 5101008768 | MI | Primary |
Addresses
Primary practice location
251 E Peck Rd
Peck, MI 48466-9589
Mailing address
PO Box 129
Yale, MI 48097
Phone (810) 387-2175
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0857600424 | Other | MI | BLUE CROSS BLUE SHIELD MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Peck, MI
- NPI 1881855328
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1194701946",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 129",
"city": "YALE",
"state": "MI",
"postal_code": "48097",
"telephone_number": "810-387-2175",
"fax_number": "810-378-4905"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "251 E PECK RD",
"city": "PECK",
"state": "MI",
"postal_code": "484669589",
"telephone_number": "810-378-4900",
"fax_number": "810-378-4905"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAMBACHER",
"first_name": "KENNETH",
"middle_name": "EUGENE",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-22",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "5101008768",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD MI",
"identifier": "0857600424",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Peck, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.