Michael Stack MD PC
Organization Active NPI Rural Health Clinic/Center · Ithaca, MI
NPI 1376580175 · NPPES record last updated Jan 8, 2009
Key facts
- NPI
- 1376580175
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- 4301064712 (MI)
- Legal business name
- MICHAEL STACK MD PC
- Practice address
- 121 N Pine River St
Ithaca, MI 48847-1039 - Phone
- (989) 875-5111
- Fax
- (989) 875-5023
- NPI assigned
- Jun 1, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Michael Andrew Stack, MD
- Title
- Owner
- Phone
- (989) 875-5111
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | MI | ||
| Rural Health Clinic/Center | 261QR1300X | 4301064712 | MI | Yes |
| Family Nurse Practitioner |
363LF0000X | MI |
Addresses
Primary practice location
121 N Pine River St
Ithaca, MI 48847-1039
Mailing address
121 N Pine River St
Ithaca, MI 48847-1039
Phone (989) 875-5111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0B91071 | Other | MI | BCBSM |
Other names
- Family Medical Care
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 8, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.