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Individual
MATTHEW A STACK
Active
Individual
MATTHEW A STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA C
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
6301007939
MI
363A00000X
Physician Assistant
2782
AZ
363A00000X
Physician Assistant
Primary
5601003961
MI
363AM0700X
Medical Physician Assistant
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0852900260
BCBSM
MI
01
—
50155318
MEDICAID
NM
05
—
762246
—
AZ
01
—
P00140431
RAILROAD
AZ
Enumeration date
10/17/2005
Last updated
02/05/2026
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