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Organization
MICHAEL STACK MD PC
Active
Organization
MICHAEL STACK MD PC
Active
Other names
Family Medical Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL ANDREW STACK MD (OWNER)
(989) 875-5111
Entity
Organization
Contact information
Practice address
121 N PINE RIVER ST, ITHACA, MI 48847-1039
(989) 875-5111
(989) 875-5023
Mailing address
121 N PINE RIVER ST, ITHACA, MI 48847-1039
(989) 875-5111
(989) 875-5023
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
MI
261QR1300X
Rural Health Clinic/Center
Primary
4301064712
MI
363LF0000X
Family Nurse Practitioner
—
MI
Other
Enumeration date
06/01/2006
Last updated
01/08/2009
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