Individual
DR. MICHAEL T STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD PHD
Contact information
Practice address
6447 S EAST ST STE A, INDIANAPOLIS, IN 46227-2119
(317) 859-6364
(317) 859-7537
Mailing address
6551 FORREST COMMONS BLVD, INDIANAPOLIS, IN 46227-2392
Taxonomy
Speciality
Code
Description
License number
State
1744R1102X
Research Study Specialist
01026374
IN
207RR0500X
Rheumatology Physician
01026374
IN
207RR0500X
Rheumatology Physician
Primary
71508
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000318888
BLUE CROSS BLUE SHIELD
IN
05
—
100083069
—
WI
05
—
100133510B
—
IN
01
—
1265457774
OFFICE/GROUP NPI
—
Enumeration date
06/01/2005
Last updated
01/06/2022
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