Individual
EDWARD P STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5300 GATEWAY CTR, FLINT, MI 48507-3930
(810) 720-9111
(810) 720-9119
Mailing address
5300 GATEWAY CTR, FLINT, MI 48507-3930
(810) 720-9111
(810) 720-9119
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
4301065179
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000010198
CAPE MEDICAID
MI
01
—
028341
MIDWEST HEALTH
MI
01
—
110201
CARE CHOICES
MI
01
—
15474
SPECTERA
MA
01
—
1802511821
BCBSM
MI
01
—
4301065179
STATE LICENSE NUMBER
MI
05
—
4604520
—
MI
05
—
4774225
—
MI
01
—
5100110
AETNA
MI
01
—
6736673005
CIGNA
MI
01
—
C6993
MCARE
MI
Enumeration date
05/24/2005
Last updated
12/06/2023
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