Individual
ROBERT KEVIN STACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1928 RANDOLPH RD STE 308, CHARLOTTE, NC 28207-1105
(704) 333-1363
(704) 333-6617
Mailing address
1928 RANDOLPH RD STE 308, CHARLOTTE, NC 28207-1105
(704) 333-1363
(704) 333-6617
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
26989
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8979122
—
NC
Enumeration date
09/27/2006
Last updated
07/21/2022
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