Individual
DR. KENNETH EUGENE DAMBACHER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
251 E PECK RD, PECK, MI 48466-9589
(810) 378-4900
(810) 378-4905
Mailing address
PO BOX 129, YALE, MI 48097
(810) 387-2175
(810) 378-4905
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101008768
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0857600424
BLUE CROSS BLUE SHIELD MI
MI
Enumeration date
12/22/2005
Last updated
07/08/2007
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