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
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0B91071
BCBSM
MI
Enumeration date
06/01/2006
Last updated
01/08/2009
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