Stack, Michael T

Stack, Michael T is an individual health care provider with primary practice located at 6447 S East St Ste A , Indianapolis IN 46227-2119. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Research Study, Allopathic & Osteopathic Physicians / Rheumatology. Allopathic & Osteopathic Physicians / Rheumatology is his primary health care specialty. Stack, Michael T can be contacted via phone (317) 859-6364.

Contact Information

Primary practice address
6447 S East St Ste A Indianapolis IN 46227-2119
Phone: (317) 859-6364
Fax: (317) 859-7537
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Research Study 1744R1102X 01026374 Indiana
Allopathic & Osteopathic Physicians / Rheumatology 207RR0500X 01026374 Indiana
Allopathic & Osteopathic Physicians / Rheumatology 207RR0500X 71508 Wisconsin

Profile Details

NPI number 1770585945
LBN Legal business name Stack, Michael T
Credentials MD PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 1st, 2005
Last updated Jan 6th, 2022 - about 3 years 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 1770585945 NPPES
Indiana MEDICAID 100133510B
Indiana Other 1265457774
Indiana MEDICAID 100083069
Indiana Other 000000318888

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