# MATTHEW A STACK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1033108667
- **Gender:** Man
- **Credential:** PA C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | 6301007939 | MI | — |
| 363A00000X | Physician Assistant | 2782 | AZ | — |
| 363A00000X | Physician Assistant | 5601003961 | MI | Yes |
| 363AM0700X | Medical Physician Assistant | — | NULL | — |

## Other

- **Enumeration date:** 10/17/2005
- **Last updated:** 02/05/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0852900260 | BCBSM | MI |
| 01 | — | 50155318 | MEDICAID | NM |
| 05 | — | 762246 | — | AZ |
| 01 | — | P00140431 | RAILROAD | AZ |