Stack, Matthew A

Stack, Matthew A is an individual health care provider with primary practice located at 121 N Pine River St , Ithaca MI 48847-1039. He recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Psychologist, Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Stack, Matthew A can be contacted via phone (989) 287-0662.

Contact Information

Primary practice address
121 N Pine River St Ithaca MI 48847-1039
Phone: (989) 287-0662
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 6301007939 Michigan
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 2782 Arizona
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 5601003961 Michigan

Profile Details

NPI number 1033108667
LBN Legal business name Stack, Matthew A
Credentials PA C
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 17th, 2005
Last updated Feb 5th, 2026 - about 8 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033108667 NPPES
Arizona Other P00140431 RAILROAD
Arizona Other 0852900260 RAILROAD
Arizona MEDICAID 762246 RAILROAD
Arizona Other 50155318 RAILROAD

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