# MICHAEL STACK MD PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Family Medical Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376580175
- **Authorized official:** DR. MICHAEL ANDREW STACK MD (OWNER)
- **Authorized official phone:** (989) 875-5111

## Contact information

- **Practice address:** 121 N PINE RIVER ST, ITHACA, MI 48847-1039
- **Practice address phone:** (989) 875-5111
- **Practice address fax:** (989) 875-5023
- **Mailing address:** 121 N PINE RIVER ST, ITHACA, MI 48847-1039
- **Mailing address phone:** (989) 875-5111
- **Mailing address fax:** (989) 875-5023

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | MI | — |
| 261QR1300X | Rural Health Clinic/Center | 4301064712 | MI | Yes |
| 363LF0000X | Family Nurse Practitioner | — | MI | — |

## Other

- **Enumeration date:** 06/01/2006
- **Last updated:** 01/08/2009